Using machine learning to increase access to and engagement with trauma-focused interventions for posttraumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) poses a global public health challenge. Evidence-based psychotherapies (EBPs) for PTSD reduce symptoms and improve functioning (Forbes et al., Guilford Press, 2020, 3). However, a number of barriers to access and engagement with these interventions prevail. As a result, the use of EBPs in community settings remains disappointingly low (Charney et al., Psychological Trauma: Theory, Research, Practice, and Policy, 11, 2019, 793; Richards et al., Community Mental Health Journal, 53, 2017, 215), and not all patients who receive an EBP for PTSD benefit optimally (Asmundson et al., Cognitive Behaviour Therapy, 48, 2019, 1). Advancements in artificial intelligence (AI) have introduced new possibilities for increasinfg access to and quality of mental health interventions. AIMS: The present paper reviews key barriers to accessing and engaging in EBPs for PTSD, discusses current applications of AI in PTSD treatment and provides recommendations for future AI integrations aimed at reducing barriers to access and engagement. DISCUSSION: We propose that AI may be utilized to (1) assess treatment fidelity; (2) elucidate novel predictors of treatment dropout and outcomes; and (3) facilitate patient engagement with the tasks of therapy, including therapy practice. Potential avenues for technological advancements are also considered.

Emotion Dysregulation in Personality Disorders.

PURPOSE OF REVIEW: This manuscript aims to take stock of emotion dysregulation and personality disorder (PD) research, review key findings, and highlight future directions. RECENT FINDINGS: Most emotion dysregulation research in PDs has focused on borderline personality disorder (BPD). BPD is characterized by high baseline negative emotion and the use of maladaptive emotion regulation strategies, but several other emotion dysregulation components may not be pervasively evident in the disorder. Trends in the BPD field that add nuance to the study of emotion dysregulation suggest that BPD may involve problems in the flexible, contextually based selection/implementation of emotion regulation strategies, as well as the development of appropriate emotion regulatory goals. Furthermore, relational stressors may elicit and maintain emotion dysregulation in BPD. Less research has examined emotion dysregulation in other PDs, but several PDs may involve deficits in emotional processes (e.g., lower behavioral inhibition and resistance of emotion-related impulses), particularly in interpersonal contexts. Emotion dysregulation is a nuanced and contextual problem which, for some PDs, may be particularly nested within interpersonal contexts. The BPD field and the increasing nuance of the study of emotion dysregulation within it points to key future research directions for the broader PD field.

Partner outcomes from an uncontrolled trial of Couple HOPES: A guided online couple intervention for posttraumatic stress disorder and relationship enhancement.

Posttraumatic stress disorder (PTSD) is associated with significant individual and relationship impairment for people with PTSD and their romantic partners. Conjoint treatments, such as cognitive behavioral conjoint therapy for PTSD (CBCT), are designed to address individual and relationship factors, yet significant barriers impede accessing in-person therapy. Couple HOPES (i.e., Helping Overcome PTSD and Enhance Satisfaction) is a coach-guided, online couple intervention for PTSD based on CBCT that was designed to address these barriers. Previous investigations have found preliminary efficacy of Couple HOPES for improving PTSD symptoms, relationship functioning, and some individual functioning domains for the partner with probable PTSD. However, no study to date has tested individual outcomes for romantic partners, which is needed to fully evaluate the intervention's promise. The current study tested these partner outcomes in a combined, uncontrolled sample of 27 couples. Intent-to-intervene analyses found significant improvements at postintervention in four of eight tested outcomes, including ineffective arguing, g = 0.74; anger, g = 0.32; perceived health, g = 0.67; and quality of life, g = 0.56. Depressive symptoms, generalized anxiety, alcohol misuse, and work functioning did not significantly change, gs = 0.17-0.42. Among participants who completed a 1-month follow-up assessment, generalized anxiety, g = 0.43, and perceived health, g = 0.73, significantly improved over follow-up, whereas anger, g = -0.48, lost gains previously made. Results were largely consistent in the completer sample. These findings show the potential of Couple HOPES to have broad benefits not only for individuals with probable PTSD but also for their romantic partners.

Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm.

BACKGROUND: Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups. METHODS: Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits. RESULTS: Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group. CONCLUSIONS: There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.

Estimating posttraumatic stress disorder severity in the presence of differential item functioning across populations, comorbidities, and interview measures: Introduction to Project Harmony.

Multiple factor analytic and item response theory studies have shown that items/symptoms vary in their relative clinical weights in structured interview measures for posttraumatic stress disorder (PTSD). Despite these findings, the use of total scores, which treat symptoms as though they are equally weighted, predominates in practice, with the consequence of undermining the precision of clinical decision-making. We conducted an integrative data analysis (IDA) study to harmonize PTSD structured interview data (i.e., recoding of items to a common symptom metric) from 25 studies (total N = 2,568). We aimed to identify (a) measurement noninvariance/differential item functioning (MNI/DIF) across multiple populations, psychiatric comorbidities, and interview measures simultaneously and (b) differences in inferences regarding underlying PTSD severity between scale scores estimated using moderated nonlinear factor analysis (MNLFA) and a total score analog model (TSA). Several predictors of MNI/DIF impacted effect size differences in underlying severity across scale scoring methods. Notably, we observed MNI/DIF substantial enough to bias inferences on underlying PTSD severity for two groups: African Americans and incarcerated women. The findings highlight two issues raised elsewhere in the PTSD psychometrics literature: (a) bias in characterizing underlying PTSD severity and individual-level treatment outcomes when the psychometric model underlying total scores fails to fit the data and (b) higher latent severity scores, on average, when using DSM-5 (net of MNI/DIF) criteria, by which multiple factors (e.g., Criterion A discordance across DSM editions, changes to the number/type of symptom clusters, changes to the symptoms themselves) may have impacted severity scoring for some patients.

Predicting the effectiveness of engagement and disengagement emotion regulation based on emotional reactivity in borderline personality disorder.

Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), sympathetic (skin conductance responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them.

Social-Emotional Profiles of PTSD, Complex PTSD, and Borderline Personality Disorder Among Racially and Ethnically Diverse Young Adults: A Latent Class Analysis.

The debate around the construct validity of complex posttraumatic stress disorder (CPTSD) has begun to examine whether CPTSD diverges from posttraumatic stress disorder (PTSD) when it co-occurs with the diagnosis of borderline personality disorder (BPD). The present study (a) examined the construct validity of CPTSD through a latent class analysis of a non-treatment-seeking sample of young trauma-exposed adults and (b) characterized each class in terms of trauma characteristics, social emotions (e.g., shame, guilt, blame), and interpersonal functioning. A total of 23 dichotomized survey items were chosen to represent the symptoms of PTSD, CPTSD, and BPD and administered to 197 trauma-exposed participants. Fit statistics compared models with 2-4 latent classes. The four-class model showed the best fit statistics and clinical interpretability. Classes included a "high PTSD+CPTSD+BPD" class, characterized by high-level endorsement of all symptoms for the three diagnoses; a "moderate PTSD+CPTSD+BPD" class, characterized by endorsement of some symptoms across all three diagnoses; a "PTSD" class, characterized by endorsement of the ICD-11 PTSD criteria; and a "healthy" class, characterized by low symptom endorsement overall. Pairwise comparisons showed individuals in the high PTSD+CPTSD+BPD class to have the highest levels of psychological distress, traumatic event history, adverse childhood experiences, and PTSD symptoms. Shame was the only social emotion to significantly differ between the classes, p = .002, η² = .16. The findings diverge from the literature, indicating an overlap of PTSD, CPTSD, and BPD symptoms in a non-treatment-seeking community sample. Further, shame may be a central emotion that differentiates between presentation severities following trauma exposure.

Putting the Patient Back in Clinical Significance: Moderated Nonlinear Factor Analysis for Estimating Clinically Significant Change in Treatment for Posttraumatic Stress Disorder.

The present study introduced a modernized approach to Jacobson and Truax's (1991) methods of estimating treatment effects on individual-level (a) movement from the clinical to the normative range and (b) reliable change on posttraumatic stress disorder (PTSD) severity. Participants were 450 trauma-exposed women (M age = 39.2 years, SD = 8.9, range: 18-65 years) who presented to seven geographically diverse community mental health and substance use treatment centers. Data from 53 of these women, none of whom met the criteria for full or subthreshold PTSD, were used to establish the normative range. Using moderated nonlinear factor analysis (MNLFA) scale scoring, which weights symptoms by their clinical relevance, a significantly larger proportion of participants moved into the normative range for PTSD severity scores and/or exhibited reliable changes after treatment compared to the same individuals' movement when using symptom counts. Further, approximately 24% of the participants showed discrepant judgments on reliable change indices (RCI) between MNLFA scores and symptom counts, likely due to the false assumption that the standard error of measurement is equal for all levels of underlying PTSD severity when estimating RCIs with symptom counts. An MNLFA approach to estimating underlying PTSD severity can provide clinically meaningful information about individual-level change without the de facto assumption that PTSD symptoms have equivalent weight. Study implications are discussed with regard to a joint emphasis on (a) measurement models that highlight differential symptom weighting and (b) treatment-arm differences in individual-level outcomes rather than the current overemphasis of treatment-arm differences on group-averaged trajectories.

Identifying Change Targets for Posttraumatic Stress Disorder Among Suicidal and Self-Injuring Women With Borderline Personality Disorder.

Research on psychotherapies for posttraumatic stress disorder (PTSD) is increasingly focused on understanding not only which treatments work but why and for whom they work. The present pilot study evaluated the temporal relations between five hypothesized change targets-posttraumatic cognitions, guilt, shame, general emotion dysregulation, and experiential avoidance-and PTSD severity among women with PTSD, borderline personality disorder, and recent suicidal and/or self-injurious behaviors. Participants (N = 26) were randomized to receive 1 year of dialectical behavior therapy (DBT) with or without the DBT prolonged exposure (DBT PE) protocol for PTSD. Potential change targets and PTSD were assessed at 4-month intervals during treatment and at 3-month posttreatment follow-up. Time-lagged mixed-effects models indicated that between-person differences in all change targets except guilt were associated with more severe PTSD, η2 s = .32-.55, and, except for general emotion dysregulation, slowed the rate of change in PTSD severity over time, η2 s = .20-.39. In DBT but not in DBT + DBT PE, individuals with higher levels of guilt and experiential avoidance relative to their own average had more severe PTSD at the next assessment point, η2 s = .12-.25. The associations between the proposed change targets and PTSD severity were not bidirectional, except for general emotion dysregulation, η2 = .50; and posttraumatic cognitions, η2 = .06. These preliminary findings suggest that trauma-related cognitions, shame, and guilt, as well as problems regulating them, may be important change targets for improving PTSD in this patient population.

Prevalence and Correlates of Concurrent and Simultaneous Cannabis and Cigarette Use among Past-Year Cannabis-Using US College Students.

Background: Cannabis and tobacco use are significant public health concerns among young adults, with concurrent (in the same time period) and simultaneous (at the same time so the effects overlap) use of both substances on the rise. Few studies have examined these behaviors among college students. Objective: We examined the prevalence of concurrent and simultaneous cannabis and cigarette (combustible or electronic) use among a sample of college students and characterized the psychosocial predictors of concurrent and simultaneous use compared to using cannabis alone. Methods: Data on past-3 months cannabis and cigarette use were collected on 1352 college students who were past-year cannabis and alcohol users yielding four groups: cannabis-only users (n = 686), concurrent cannabis and cigarette users (CCAC; n = 235), simultaneous cannabis and cigarette users (SCAC; n = 293), and non-recent users of either substance (n = 138). Multinomial logistic regression analyses were utilized to predict group membership. Results: Relative to the cannabis-only group, White, compared to Non-White students, males, compared to females, frequent, compared to infrequent, alcohol users, including those who used alcohol simultaneously with cigarettes, and illicit drug users were more likely to belong to the CCAC or SCAC group. Conclusions: Findings suggest the need for unique intervention efforts to prevent onset or reduce co-use among male and White students as well as illicit drug users and frequent alcohol users.

How do you choose and how well does it work?: the selection and effectiveness of emotion regulation strategies and their relationship with borderline personality disorder feature severity.

There is little research examining whether the selection of emotion regulation strategies is compromised among individuals characterised by emotion dysregulation. In a sample of 149 undergraduates, we examined the selection and effectiveness of 2 emotion regulation strategies (reappraisal or distraction) in response to emotionally evocative stimuli, and their relationship with emotion dysregulation, measured by borderline personality disorder (BPD) feature severity. Stimulus intensity and self-reported negative emotional intensity were also compared as predictors of strategy selection. Results indicated that self-reported negative emotional intensity was a stronger predictor of strategy selection than stimulus intensity, and participants generally selected reappraisal over distraction. However, increases in self-reported negative emotional intensity was associated with an increased likelihood of choosing distraction, particularly among individuals higher in BPD features. In general, distraction exhibited less effectiveness than reappraisal, and higher BPD features did not differentially impact such effectiveness. Our findings indicate that individuals higher in emotion dysregulation prefer to use distraction as self-reported negative emotional intensity increases, a strategy which, overall, may not be as effective as reappraisal. Selection, rather than effectiveness of emotion regulation strategy might be a key feature of individuals characterised by emotion dysregulation.

Borderline personality disorder and social connectedness: A systematic review.

Borderline personality disorder (BPD) is a debilitating disorder characterized by deficits in social connectedness, which is a multifaceted construct with structural (i.e., the number, diversity, or frequency of social relationships), functional (i.e., the actual or perceived resources relationships provide), and quality (i.e., the positive and negative aspects of social relationships) elements (Holt-Lunstad, 2018). However, the literature is sparse and lacks integration regarding which specific elements of social connectedness are deficient in BPD and why. This systematic review synthesized the literature on the bidirectional relationship of social connectedness and BPD. Electronic searches of three databases (i.e., PsycInfo, PsycArticles, and PubMed) identified 1,962 articles which underwent title and abstract screening and, if potentially eligible, full-text review. Sixty two articles met the eligibility criteria and underwent data extraction and risk of bias assessment. Cross-sectional research supported associations between BPD and problems in structural, functional, and quality social connectedness, with most research underscoring deficits in quality social connectedness. Preliminary longitudinal research suggested that BPD pathology predicts problems across these domains, but little to no research exists testing the reverse direction. Although people with BPD may not have difficulties forming relationships, they exhibit a range of problems within those relationships. BPD may elicit such problems in social connectedness, but it is unclear whether such issues reciprocally exacerbate and elicit BPD, and longitudinal research investigating such directionality is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders.

We conducted a systematic review and network meta-analyses (NMA) of psychotherapy and pharmacologic treatments for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol or other drug use disorder (AOD). A comprehensive search spanning 1995-2019 yielded a pool of 39 studies for systematic review, including 24 randomized controlled trials for the NMA. Study interventions were grouped by target of treatment (PTSD + AOD, PTSD-only, and AOD-only) and approach (psychotherapy or medication). Standardized mean differences (SMD) from the NMA yielded evidence that at the end of treatment, integrated, trauma-focused therapy for PTSD + AOD was more effective at reducing PTSD symptoms than integrated, non-trauma-focused therapy (SMD = -0.30), AOD-focused psychotherapy (SMD = -0.29), and other control psychotherapies (SMD = -0.43). End-of-treatment alcohol use severity was less for AOD medication compared to placebo medication (SMD = -0.36) and trauma-focused therapy for PTSD + placebo medication (SMD = -0.67), and less for trauma-focused psychotherapy + AOD medication compared to PTSD medication (SMD = -0.53), placebo medication (SMD = -0.50), and trauma-focused psychotherapy + placebo medication (SMD = -0.81). Key limitations include the small number of studies in the NMA for pharmacologic treatments and the lack of demographic diversity apparent in the existing literature. Findings suggest room for new studies that can address limitations in study sample composition, sample sizes, retention, and apply new techniques for conducting comparative effectiveness in PTSD + AOD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A case series of sage: a new couple-based intervention for borderline personality disorder.

BACKGROUND: Research suggests that interpersonal dysfunction may be central to borderline personality disorder (BPD), and that the relationships of people with BPD are particularly impaired. Further, the significant others of people with BPD exhibit elevated psychological problems but little access to mental healthcare. Despite this, most BPD interventions are delivered individually and do not routinely incorporate significant others. This manuscript presents the first case series of Sage, a 12-session manualized intervention for people with borderline personality disorder (BPD) and their intimate partners with three targets: a) BPD severity, b) relationship conflict, and c) intimate partner mental health. FINDINGS: Five couples of people with BPD with frequent suicidal/self-injurious behavior or high suicidal ideation and their intimate partners received Sage. Measures of Sage targets as well as tertiary outcomes were administered at pre-, mid-, and post-intervention. Four out of five dyads completed Sage, with high intervention satisfaction ratings. Improvements were generally demonstrated in BPD severity, suicidal ideation, and suicidal behavior/self-injury. Half of dyads exhibited improvements in conflict, and additional improvements in mental health outcomes for dyad members were demonstrated. One dyad exhibited poor outcomes and speculations regarding this are offered. CONCLUSIONS: Findings provide proof of concept of Sage as an intervention that can improve BPD and other mental health outcomes in those with BPD and their intimate partners. Incorporating intimate partners into BPD treatment may optimize and expedite its outcomes. However, further testing is needed. TRIAL REGISTRATION: This project was pre-registered at Clinicaltrials.gov (Identifier: [NCT04737252]).

Discrepancies confer vulnerability to depressive symptoms: a three-wave longitudinal study.

Discrepancies (i.e., a subjective sense of falling short of one's own standards) are a key part of the perfectionism construct. Theory suggests discrepancies confer vulnerability to depressive symptoms. Since most research in this area is cross-sectional, longitudinal research is needed to disentangle directionality of relationships and to permit stronger causal inferences. Determining whether discrepancies are an antecedent of depressive symptoms, a consequence of depressive symptoms, or both is critical to understanding the discrepancies-depressive symptoms relationship. Knowledge about the temporal stability of discrepancies is also only starting to emerge, and it is unclear whether discrepancies predict incremental variance in depressive symptoms above and beyond neuroticism (i.e., a dispositional tendency to experience negative emotional states). The present study tested relationships among discrepancies, neuroticism, and depressive symptoms in 127 1st-year undergraduates using a 3-wave longitudinal design. Results suggest discrepancies may be understood as a trait-state where people are both highly consistent in their rank order on discrepancies and fluctuate somewhat in the level of discrepancies they experience at a particular point in time. As hypothesized, discrepancies predicted increases in depressive symptoms, even after controlling for neuroticism. Contrary to hypotheses, depressive symptoms did not predict changes in discrepancies. This study extends a long tradition of theory noting the depressing consequences of believing that one has fallen short of one's own standards. Harsh self-criticism and unobtainable self-expectations involving a strong sense of imperfection may be part of the premorbid personality of people vulnerable to depressive symptoms.

The relationship between emptiness and suicide and self-injury urges in borderline personality disorder.

INTRODUCTION: Suicide and self-injury (SSI) are pervasive among individuals with borderline personality disorder (BPD), yet little research has examined factors that increase SSI urges among those with BPD. Emptiness is a diagnostic criterion of BPD that is associated with SSI behaviors, but its impact on SSI urges in BPD is poorly understood. This study investigates the association between emptiness and SSI urges at baseline and in response to a stressor (i.e., reactivity) among individuals with BPD. METHODS: Forty individuals with BPD participated in an experimental procedure where they rated their degree of emptiness and SSI urges at baseline and in response to an interpersonal stressor. Generalized estimating equations tested whether emptiness predicts baseline SSI urges and SSI urge reactivity. RESULTS: Higher emptiness predicted higher baseline suicide urges (B = 0.006, SE = 0.002, p < 0.001), but not baseline self-injury urges (p = 0.081). Emptiness did not significantly predict suicide urge reactivity (p = 0.731) nor self-injury urge reactivity (p = 0.446). CONCLUSION: Assessing and targeting emptiness may facilitate the reduction of suicide urges in BPD. Future research should investigate treatment strategies for reducing SSI risk among individuals with BPD via targeting emptiness.

PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies.

OBJECTIVE: Sexual assault is associated with higher rates of posttraumatic stress disorder (PTSD) than other traumas, and the course of PTSD may differ by trauma type. However, the course of PTSD after sexual assault has not been summarized. The aim of this meta-analysis was to identify the prevalence and severity of PTSD and changes to the average rate of recovery in the 12 months following sexual assault. METHOD: Authors searched four databases for prospective studies published before April 2020 and sought relevant unpublished data. Eligible studies assessed PTSD in at least 10 survivors of sexual assault in at least two time points, starting within 3 months postassault. Random effects linear-linear piecewise models were used to identify changes in average recovery rate and produce model-implied estimates of monthly point prevalence and mean symptom severity. RESULTS: Meta-analysis of 22 unique samples (N = 2,106) indicated that 74.58% (95% confidence interval [CI]: [67.21, 81.29]) and 41.49% (95% CI: [32.36, 50.92]) of individuals met diagnostic criteria for PTSD at the first and 12th month following sexual assault, respectively. PTSD symptom severity was 47.94% (95% CI: [41.27, 54.61]) and 29.91% (95% CI: [23.10, 36.73]) of scales' maximum severity at the first and 12th month following sexual assault, respectively. Most symptom recovery occurred within the first 3 months following sexual assault, after which point the average rate of recovery slowed. CONCLUSIONS: Findings indicate that PTSD is common and severe following sexual assault, and the first 3 months postassault may be a critical period for natural recovery.

Latent emotion profiles of PTSD and specific emotions predicting differential therapy outcomes in a dismantling study of cognitive processing therapy.

Posttraumatic stress disorder (PTSD) is theoretically maintained by avoidance of emotions elicited from trauma-related beliefs. Whether PTSD symptom profiles and specific emotions predict treatment response is unknown. This secondary data analysis examined: a) whether individuals with PTSD can be sub-classified based on symptom clusters and specific emotions, and b) if these subgroups predict differential responses to cognitive versus exposure-based PTSD interventions. Women with physical or sexual assault-related PTSD were randomized to CPT (cognitive processing therapy elements only), CPT with written accounts (CPT+A), or written accounts (WA) only (n = 150). Participants completed baseline measures of PTSD, state anxiety, internalized anger, externalized anger, shame, and guilt, and weekly PTSD measures during and 6 months after treatment. Latent profile analyses revealed four subgroups: low symptoms and emotions; moderate-high reexperiencing, low internalized emotions (i.e., moderate-high reexperiencing, moderate avoidance/hyperarousal/guilt, low shame/internalized anger/anxiety); low reexperiencing, moderate emotions (i.e., low re-experiencing, moderate avoidance/hyperarousal/guilt, moderate other emotions); and high symptoms and emotions (high symptoms and emotions except moderate externalized anger). The high symptom and emotion subgroup experienced greater PTSD symptom improvements in cognitive conditions than WA. Other groups did not exhibit differential change across conditions. Cognitive interventions may be well-suited for severe PTSD with high self-directed emotions. CLINICALTRIALS.GOV IDENTIFIER: NCT00245232.

The influence of sleep on emotion dysregulation in borderline personality disorder, generalized anxiety disorder, and healthy controls.

Emotion dysregulation is central to borderline personality disorder (BPD) and exacerbated by sleep disruptions. This study investigated whether homeostatic (i.e., sleep efficiency), circadian (i.e., chronotype), and subjective (i.e., sleep quality) sleep elements predict emotion dysregulation in BPD, healthy controls (HCs), and a generalized anxiety disorder (GAD) group. Participants (N = 120) with BPD, GAD, and HCs completed daily sleep measures for seven days prior to an experiment wherein baseline emotion, emotional reactions to stressors (i.e., reactivity), and the extent to which they can decrease their emotion using mindfulness and distraction (i.e., emotion regulation) were measured across self-reported, sympathetic, and parasympathetic emotion. Across groups, earlier chronotypes and higher sleep quality predicted less self-reported baseline negative emotion, and higher sleep quality predicted better parasympathetic emotion regulation. For HCs, higher sleep efficiency and lower sleep quality predicted higher parasympathetic baseline emotion, and higher sleep efficiency predicted more self-reported baseline negative emotion. Also in HCs, earlier chronotype predicted better sympathetic emotion regulation, and there was a quadratic relationship between sleep efficiency and self-reported emotion regulation. Optimizing sleep quality and improving alignment between chronotype and daily living may improve baseline emotion and emotion regulation. Healthy individuals may be particularly vulnerable to high or low sleep efficiency.