Elucidating the Association Between Military Sexual Trauma Types and Different Types of Risky Behaviors.

Military sexual harassment (MSH) and assault (MSA) are associated with serious mental and physical health outcomes among military personnel and veterans. However, less is known about how these experiences relate to risky, impulsive, and health-compromising behaviors. The goal of the current study was to assess MSH and MSA in relation to a wide range of risky behaviors. Participants were 512 veterans in the community (M age = 41.36, 71.3% male, 71.3% white) who completed an online survey via Amazon's Mechanical Turk (MTurk). Compared to veterans who reported MSH only or no history of MST, veterans with a MSA history reported greater past-month risky behavior engagement, both overall and for specific behaviors, including problematic use of alcohol, drugs, gambling, technology, risky sexual behaviors, eating behaviors, illegal behaviors, reckless spending, physically aggressive behaviors, verbally aggressive behaviors, property destruction, reckless driving, non-suicidal self-injury, and suicidal behavior. Our findings emphasize the importance of differentiating between MSH and MSA when detecting and intervening with veterans at risk for engaging in risky behaviors.

Posttraumatic stress disorder symptoms moderate the relation between childhood sexual abuse and disordered eating in a community sample.

OBJECTIVE: Previous work has found clear associations between childhood sexual abuse (CSA) and disordered eating in adulthood. However, further research is needed to clarify factors that may influence this relationship. The current study advanced existing research by examining the moderating influence of posttraumatic stress disorder (PTSD) symptom severity in the association between CSA and disordered eating. METHOD: Data were collected from 463 individuals with a history of sexual assault or other unwanted sexual experience(s) (Mage  = 34.71, 54.9% women, 77.5% white) who were recruited from MTurk. RESULTS: Results indicated significant positive relations among CSA, PTSD symptom severity, and disordered eating. CSA was found to be associated with disordered eating at high, but not low, levels of PTSD symptom severity. DISCUSSION: This study highlights the importance of assessing disordered eating and PTSD symptoms in individuals who report a history of CSA. Clinicians aiming to reduce their patients' symptoms of disordered eating may benefit from considering the potential role of PTSD symptom severity as a barrier to achieving treatment gains.

The moderating role of emotion dysregulation in the relation between potentially morally injurious experiences and alcohol misuse among military Veterans.

Alcohol misuse is a serious and pervasive problem among US military Veterans. The commission or omission of acts that transgress important moral standards, known as potentially morally injurious events (PMIEs), has been theoretically and empirically linked to alcohol misuse in this population. Emotion dysregulation has been implicated in the pathogenesis of alcohol misuse and may be relevant in the context of PMIEs. The goal of this study was to examine the roles of negative and positive emotion dysregulation in the relation between PMIEs and alcohol misuse. Participants were a community sample of US military Veterans who were predominantly white (69.5%) and male (71.6%), with a mean age of 38.00. The interaction between PMIEs and both negative and positive emotion dysregulation (separately) significantly predicted alcohol misuse. Simple slopes tests revealed that the relation between PMIEs and alcohol misuse was only significant at high levels of negative and positive emotion dysregulation. Findings underscore the potential utility of targeting both negative and positive emotion dysregulation in alcohol misuse interventions for military Veterans experiencing PMIEs.

Positive Emotion Dysregulation Among Community Individuals: The Role of Trauma Exposure and Posttraumatic Stress Disorder.

Existing literature has provided support for an association between posttraumatic stress disorder (PTSD) and emotion dysregulation. However, few studies have examined the relation between PTSD and emotion dysregulation that stems from positive emotions. Moreover, the role of trauma exposure, per se, on positive emotion dysregulation is unknown. Addressing these limitations, the current study compared levels of positive emotion dysregulation among (a) individuals without trauma exposure, (b) trauma-exposed individuals without probable PTSD, and (c) trauma-exposed individuals with probable PTSD. Participants were 400 community-dwelling individuals (M age = 43.76 years, 68.6% female; 24.2% Asian, 23.7% Black, 24.5% Hispanic, 27.6% White). Lower levels of positive emotion dysregulation were found among trauma-exposed participants without probable PTSD compared to trauma-exposed participants with probable PTSD, ds = 0.66-0.73, and unexposed participants, ds = 0.58-0.64. The present findings suggest the potential protective role of low levels of positive emotion dysregulation following trauma exposure. If replicated in longitudinal studies, these results may indicate the utility of enhancing skills for regulating positive emotions among individuals at risk for trauma exposure.

Do Difficulties Regulating Positive Emotions Contribute to Risky Sexual Behavior? A Path Analysis.

Within the U.S., risky sexual behavior (RSB) is the primary mode of HIV transmission. The role of emotion dysregulation in RSB has received growing attention over the past decade. However, this literature has been limited in its focus on emotion dysregulation stemming from negative (but not positive) emotions. The goal of the current study was to extend research by examining the relative and unique contributions of dimensions of difficulties regulating positive emotions (i.e., nonacceptance of positive emotions [Accept], difficulties controlling impulsive behaviors when experiencing positive emotions [Impulse], and difficulties engaging in goal-directed behaviors when experiencing positive emotions [Goals]) to RSB. Participants were 386 trauma-exposed individuals recruited from Amazon's MTurk (M age = 35.85 years; 57.5% female; 76.4% White). At the bivariate level, dimensions of difficulties regulating positive emotions were significantly positively associated with sexual risk taking with uncommitted partners, impulsive sex behaviors, and intent to engage in risky sexual behaviors (with the exception of Goals to sexual risk taking with uncommitted partners), and significantly negatively associated with risky sex acts. Regarding the unique contributions of difficulties regulating positive emotions to RSB, (1) Accept was significantly positively associated with impulsive sexual behaviors and intent to engage in risky sexual behaviors; (2) Impulse was significantly positively associated with risky anal sex acts; and (3) Goals was significantly negatively associated with risky anal sex acts. Findings suggest the potential utility of targeting difficulties regulating positive emotions in treatments aimed at reducing RSB.

Online crowdsourcing to study trauma and mental health symptoms in military populations: A case for Amazon's Mechanical Turk (MTurk) platform.

INTRODUCTION: Amazon's Mechanical Turk (MTurk) appears to be a reliable resource for studying clinical populations and accessing hard-to-reach populations. Recent research suggests that MTurk may also be a viable option for military recruitment. OBJECTIVE: The goal of the current study was to examine the utility of collecting clinical data on military samples recruited via MTurk. METHOD: Participants were 535 military veterans (Mage = 37.45; 71.8% men; 69.5% White) who completed measures assessing trauma and mental health. RESULTS: Findings indicate that rates of military traumas and mental health diagnoses were higher than published comparisons; posttraumatic stress disorder (PTSD) and depression symptoms were found to be higher than values found in a nationally representative sample, lower than a treatment-seeking sample, and comparable to a MTurk-recruited military sample. Alcohol misuse was found to be higher than both nationally representative and treatment-seeking samples. Psychometric analyses indicated support for convergent validity of measures, and confirmatory factor analysis results demonstrated that empirically supported factor models of PTSD were replicated in the current sample; the hybrid model demonstrated the best fit. CONCLUSIONS: Our findings support the utility of MTurk for collecting clinical data on military samples. Increasing access to and recruitment of military samples is important for advancing the field of military psychology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Role of positive emotion regulation strategies in the association between childhood trauma and posttraumatic stress disorder among trauma-exposed individuals who use substances.

BACKGROUND: The co-occurrence of childhood trauma and posttraumatic stress disorder (PTSD) is highly prevalent and clinically significant. Existing research emphasizes the role of emotion regulation in the relation between childhood trauma and PTSD. Yet, research in this area has almost exclusively examined the influence of strategies aimed at regulating negative emotions, such as anger and sadness. OBJECTIVE: To extend existing research, the current study examined underlying roles of strategies for regulating positive emotions (i.e., self- and emotion-focused positive rumination and positive dampening) in the association between childhood trauma severity and PTSD symptoms. PARTICIPANTS AND SETTING: Participants were 320 trauma-exposed community individuals who reported past 30-day substance use (Mage = 35.78, 50.3% men, 81.6% white). METHOD: Analyses examined whether childhood trauma severity was indirectly related to PTSD symptoms through self-focused positive rumination, emotion-focused positive rumination, and positive dampening. RESULTS: Positive dampening, but not positive self- and emotion-focused positive rumination, indirectly explained associations between childhood trauma severity and PTSD symptoms (B = .17, SE = .03, 95% CI [.12, .24]). CONCLUSIONS: These findings highlight the potential utility of targeting positive dampening in the treatment of PTSD symptoms among individuals who use substances with a history of childhood trauma.

Longitudinal Investigation of Bidirectional Relations Between Childhood Trauma and Emotion-Driven Impulsivity in the Adolescent Brain Cognitive Development Study.

OBJECTIVE: Exposure to childhood trauma is associated with numerous adverse mental health consequences. Addressing important gaps in the existing research, the proposed study clarifies the longitudinal and bidirectional associations between childhood trauma and both negative and positive emotion-driven impulsivity. METHOD: This study utilized a sample of 11,872 9- to 10-years-olds recruited from 21 research sites across the United States from the Adolescent Brain Cognitive Ddevelopment (ABCD) Study. Childhood trauma was assessed at one- and two-year follow-ups. Negative and positive urgency were assessed at baseline and two-year follow-up. Cross-lagged panel models evaluated the longitudinal and bidirectional associations between childhood trauma and both negative and positive emotion-driven impulsivity. RESULTS: Findings showed that earlier childhood trauma was associated with higher levels of later negative (ß = 0.133, p < .001) and positive (ß = 0.125, p < .001) emotion-driven impulsivity. Further, higher levels of earlier positive (ß = 0.033, p < .006), but not negative (ß = 0.010, p = .405), emotion-driven impulsivity were associated with later childhood trauma. Finally, the strength of the relations between childhood trauma and emotion-driven impulsivity did not differ by sex (ΔX2 = 10.228, p > .05). DISCUSSION: Identification of both negative and positive emotion-driven impulsivity among children exposed to trauma may serve as a point of intervention to reduce subsequent risk for deleterious health outcomes.

The differential relation of trauma types with negative and positive emotion dysregulation.

Background and Objectives: Research provides robust support for an association between traumatic exposure and emotion dysregulation. Less understood is the relation of emotion dysregulation stemming from positive emotions to traumatic exposure, or the extent to which negative and positive emotion dysregulation may be uniquely related to specific trauma types.Design and Methods: The present study explored the associations between negative and positive emotion dysregulation and specific trauma types in a community sample of 433 adults (M age = 43.81, 68.4% women).Results: Results highlighted three main findings: (1) negative and positive emotion dysregulation were significantly higher among individuals with vs. without exposure to six and nine specific trauma types, respectively; (2) negative and positive emotion dysregulation were significantly and positively related to total number of specific traumatic events; and (3) negative emotion dysregulation was significantly higher among individuals with Victimization Traumas in the overall sample as well as the no-PTSD and no-MDD subsamples, and positive emotion dysregulation was significantly lower among individuals with Accidental/Injury Traumas and Victimization Traumas in the PTSD subsample.Conclusions: Results underscore the relative and unique roles of negative and positive emotion dysregulation in trauma types; these findings may inform future research.

Posttraumatic stress disorder symptom severity modulates avoidance of positive emotions among trauma-exposed military veterans in the community.

OBJECTIVE: Theoretical and empirical evidence links emotional avoidance to the development and maintenance of posttraumatic stress disorder (PTSD) symptoms. However, few studies have tested whether these findings extend to positive emotional avoidance. Addressing this important gap in the literature, the current study examined the moderating role of PTSD symptom severity in the relation between positive emotional intensity and positive emotional avoidance. METHOD: Participants were 465 trauma-exposed veterans recruited from the community (Mage = 38.00, 71.6% male, 69.5% White). RESULTS: The interaction between positive emotional intensity and PTSD symptom severity on positive emotional avoidance was significant. Analysis of simple slopes revealed that positive emotional intensity was significantly positively associated with positive emotional avoidance when participants endorsed high, but not low, levels of PTSD symptom severity. CONCLUSIONS: Veterans with more severe PTSD symptoms may utilize avoidance strategies in the context of intense positive emotions. These findings may suggest the potential need for addressing positive emotional avoidance in interventions to reduce PTSD symptom severity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Emotion regulation and substance use: A meta-analysis.

There has been exponential growth in research on emotion regulation and substance use in the past decade. The current meta-analysis evaluated variability in the magnitude of the relation between aspects of emotion regulation and substance use. A search of PsycINFO, Embase, PubMed, CINAHL Plus, and PILOTS in December 2020 resulted in 6642 initial studies, of which 95 met inclusion criteria (association between emotion regulation and substance use was reported, participants were > 18 years old, article was in English). A total of 445 effects were obtained (N = 156,025 participants; weighted Mage = 29.31; 59.5% female; 66.1% White; 76.6% non-clinical). Emotion regulation and substance use were significantly related (r = 0.19; p < 0.001; 95%CI [0.17, 0.20]). Emotion regulation abilities were generally more strongly related to substance use than emotion regulation strategies; this pattern was stronger for behavioral vs. cognitive abilities and extended to both negative and positive emotions. Relations were stronger for older and clinical samples; mixed effects were found for sex and no conclusive effects were found for race. Despite limitations of the existing literature (e.g., cross-sectional, self-reports), results indicated that the magnitude of the relation between emotion regulation and substance use varied considerably as a function of emotion regulation and substance use constructs and sample characteristics.

Alcohol to down-regulate negative and positive emotions: Extending our understanding of the functional role of alcohol in relation to posttraumatic stress disorder.

INTRODUCTION: Functional models of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) underscore the role of internally-driven negative reinforcement. However, with the focus of these models being on negative emotions broadly, there is limited understanding of the effect of alcohol use to down-regulate specific forms of negative emotions or positive emotions generally. Among populations characterized by PTSD, there is growing evidence that positive emotions may elicit aversive reactions and thus be intentionally reduced, including via alcohol use. OBJECTIVE: The current study examined the associations among PTSD symptom severity, alcohol use to down-regulate both negative (i.e., despondency and anger) and positive emotions, and alcohol misuse. METHOD: Data were collected from 320 trauma-exposed, substance-using individuals in the community (M age = 35.78, 46.9% women). RESULTS: Individuals with greater PTSD symptom severity reported significantly higher alcohol use to down-regulate despondency, anger, and positive emotions, which, in turn, were linked to greater alcohol misuse. CONCLUSIONS: Alcohol use may serve to down-regulate both negative (i.e., despondency and anger) and positive emotions, and these functions may help to explain the association of PTSD symptom severity to alcohol misuse. PTSD-AUD models may benefit from specifying a negatively reinforcing function of alcohol use in the context of positive emotions.

Military Sexual Trauma and Risky Behaviors: A Systematic Review.

INTRODUCTION: Military sexual trauma (MST) is a serious and pervasive problem among military men and women. Recent findings have linked MST with various negative outcomes including risky, self-destructive, and health-compromising behaviors. OBJECTIVE: The current review summarizes the existing literature on the association between MST and risky behaviors among military men and women who have served in the U.S. Armed Forces. METHOD: We systematically searched five electronic databases (PubMed, EMBASE, PSYCINFO, PILOTS, and CINAHL Plus) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Of the initial 2,021 articles, 47 met the inclusion criteria. Reviewed studies revealed three patterns of findings: (1) largely studied and consistent (i.e., suicidal behaviors, disordered eating), (2) mixed and in need of future research (i.e., alcohol and drug use, smoking), and (3) underexamined (i.e., sexual behaviors, illegal/aggressive behaviors) or completely neglected (e.g., problematic technology use, gambling). DISCUSSION: The current systematic review advances literature by providing strong support for an association between MST and a wide range of risky behaviors. Moreover, it highlights important areas for future research.

The role of positive emotion dysregulation in the relationship between childhood abuse and PTSD in a community sample of veterans.

BACKGROUND: The co-occurrence of childhood abuse and posttraumatic stress disorder (PTSD) among United States military veterans is highly prevalent and clinically significant. Emotion dysregulation is one factor that has been found to underlie the association between childhood abuse and PTSD, yet past research has focused exclusively on dysregulation stemming from negative emotions. OBJECTIVE: The current study extends existing research by clarifying the role of positive emotion dysregulation in the relation between childhood abuse and PTSD in a community sample of military veterans. PARTICIPANTS AND SETTING: Participants were 465 trauma-exposed military veterans in the community (Mage = 38.00, 71.6 % women, 69.5 % White). METHOD: Using structural equation modeling, we tested the indirect association of childhood abuse to PTSD symptom severity through positive emotion dysregulation. RESULTS: The hypothesized model showed adequate model fit, χ2 (32, n = 465) = 176.22, p < .001, CFI = .97, RMSEA = .10, 90 % CI [.08, .11], SRMR = .04. Results showed that childhood abuse was indirectly associated with PTSD symptom severity through positive emotion dysregulation. CONCLUSIONS: This finding highlights the potential utility of targeting positive emotion dysregulation in the detection and treatment of PTSD symptoms in veterans who experienced childhood abuse.

Posttraumatic stress disorder and deliberate self-harm among military veterans: Indirect effects through negative and positive emotion dysregulation.

OBJECTIVE: Military veterans with posttraumatic stress disorder (PTSD) exhibit heightened rates of deliberate self-harm, yet few studies have explored underlying mechanisms. Addressing this critical gap in the literature, the present study examined the roles of negative and positive emotion dysregulation in the relation between PTSD severity and deliberate self-harm. METHOD: Data were collected from 465 trauma-exposed military veterans in the community (Mage = 38.00, 71.4% male, 69.5% White) who responded to an online survey. RESULTS: Findings indicated that PTSD severity was indirectly related to deliberate self-harm through overall positive (but not negative) emotion dysregulation. Secondary analyses indicated an underlying role of the negative emotion dysregulation domains of difficulties controlling impulsive behaviors when experiencing negative emotions and lack of emotional clarity and the positive emotion dysregulation domains of nonacceptance of positive emotions, difficulties engaging in goal-directed behavior when experiencing positive emotions, and difficulties controlling impulsive behaviors when experiencing positive emotions in the association between PTSD severity and deliberate self-harm. CONCLUSIONS: This study offers preliminary evidence for specific domains of negative and positive emotion dysregulation as possible pathways linking PTSD severity and deliberate self-harm. Findings highlight new avenues for research and treatment focused on the effects of emotion dysregulation on deliberate self-harm among trauma-exposed military veterans. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The role of gender in the associations among posttraumatic stress disorder symptom, severity, difficulties regulating emotions, and alcohol misuse.

INTRODUCTION: The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement. METHOD: The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (Mage = 35.62, 55.4% women, 77.0% White). RESULTS: Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model. CONCLUSIONS: Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.

Anxious distress in depressed outpatients: Prevalence, comorbidity, and incremental validity.

The goals of this study were to estimate the prevalence of the DSM-5 anxious distress specifier (AD) among depressed outpatients, to examine associations of AD with comorbid diagnoses, and to test the incremental validity of AD over comorbidity in predicting functional impairment and severity of anxiety and depression symptoms. The sample was 237 outpatients diagnosed with major depressive disorder (MDD) or persistent depressive disorder (PDD), with and without AD, using the Anxiety and Related Disorders Interview Schedule for DSM-5. Outpatients also completed self-report questionnaires assessing functional impairment and anxiety, stress, and depression symptom severity. Two-by-two contingency tables were used to examine the associations of AD with comorbidity. Two-thirds (66.2%) of outpatients were assigned AD, with similar rates among those with MDD and PDD. Outpatients with AD were significantly more likely than those without AD to have a comorbid GAD diagnosis (OR = 2.47). Hierarchical multiple regressions were used to test the incremental validity of AD in predicting functional impairment and symptom outcomes beyond comorbid disorders. Controlling for comorbid disorders, AD was significantly associated with more severe functional impairment, autonomic arousal, stress, panic, generalized anxiety, and depression. The strongest incremental association were observed between AD and autonomic arousal (f2 = 0.12-0.18) and generalized anxiety (f2 = 0.17). These findings add to a growing literature that AD is common among outpatients and associated with important clinical outcomes, suggesting that AD should be routinely assessed in patients with mood disorders.