Courtney E. Dutton

Disgust, mental contamination, and posttraumatic stress: Unique relations following sexual versus non-sexual assault

Disgust and mental contamination (or feelings of dirtiness and urges to wash in the absence of a physical contaminant) are increasingly being linked to traumatic event exposure and posttraumatic stress (PTS) symptomatology. Evidence suggests disgust and mental contamination are particularly relevant to sexual assault experiences; however, there has been relatively little direct examination of these relations. The primary aim of the current study was to assess disgust and mental contamination-based reactivity to an individualized interpersonal assault-related script-driven imagery procedure. Participants included 22 women with a history of traumatic sexual assault and 19 women with a history of traumatic non-sexual assault. Sexual assault and PTS symptom severity predicted greater increases in disgust, feelings of dirtiness, and urges to wash in response to the traumatic event script. Finally, assault type affected the association between PTS symptom severity and increases in feelings of dirtiness and urges to wash in response to the traumatic event script such that these associations were only significant among sexually assaulted individuals. These findings highlight the need for future research focused on elucidating the nature of the relation between disgust and mental contamination and PTS reactions following various traumatic events.

Understanding PTSD comorbidity and suicidal behavior: associations among histories of alcohol dependence, major depressive disorder, and suicidal ideation and attempts.

Individuals with posttraumatic stress disorder (PTSD) are at an elevated risk for experiencing suicidal thoughts and actions. However, a relative dearth of research has examined factors that may impact this relation, such as common co-occurring disorders. Utilizing the National Comorbidity Survey-Replication data, the current study examined comparisons between comorbid PTSD and major depressive disorder (MDD) and comorbid PTSD and alcohol dependence (AD) in relation to suicidal ideation and suicide attempts. It was hypothesized that comorbid MDD would be associated with an elevated likelihood of suicidal ideation, while comorbid AD would be associated with an elevated likelihood of suicide attempt history. Results indicated that only PTSD-AD was significantly associated with an elevated likelihood of endorsing histories of both suicidal ideation and suicide attempts. These findings suggest that AD may be a critical risk factor for acquiring the capability for suicide attempts.

Posttraumatic stress disorder and alcohol dependence: Individual and combined associations with social network problems

People with either posttraumatic stress disorder (PTSD) or alcohol dependence (AD) are apt to report problems in their social networks, including low perceived support and elevated conflict. However, little research has examined social networks among people with comorbid PTSD/AD despite evidence suggesting these two conditions commonly co-occur and are linked to particularly severe problems. To test the hypothesis that people with comorbid PTSD/AD experience particularly elevated social network problems, individuals with lifetime diagnoses of PTSD, AD, comorbid PTSD/AD, or no lifetime history of Axis I psychopathology in the National Comorbidity Survey-Replication were compared on four dimensions of social networks: (1) Closeness, (2) Conflict, (3) Family Support, and (4) Apprehension. Persons with PTSD, AD, or comorbid PTSD/AD endorsed more problems with the Conflict, Family Support, and Apprehension factors compared to people with no history of Axis I psychopathology. Moreover, individuals with comorbid PTSD/AD endorsed greater Apprehension and significantly less Family Support compared to the other three groups. Results suggest people with comorbid PTSD/AD experience increased problems with their family as well as greater concerns about enlisting social support than even people with PTSD or AD alone. Treatments for people suffering from comorbid PTSD/AD should consider assessing for and possibly targeting family support and apprehension about being close to others.

Posttraumatic Stress Disorder and Suicidal Behavior: Indirect Effects of Impaired Social Functioning

Social functioning is negatively impacted by the presence of PTSD, while increasing risk of suicidal behavior among individuals with PTSD. However, little research has examined the specific role of social functioning in the association between PTSD and suicidal behavior. Parallel multiple indirect effects analyses were performed to understand the unique indirect effects of four aspects of social functioning. Indirect effects of PTSD on suicidal ideation were significant through three pathways: interpersonal conflict, perceived family support, and interpersonal apprehension. Perceived family support was the only indirect pathway significantly associated with suicide attempt. Findings suggest that social functioning should be assessed and potentially targeted during treatment to help modify the risk for suicidal behavior among individuals with PTSD.

Alleviation of Moral Disgust, Shame, and Guilt in Posttraumatic Stress Reactions: An Evaluation of Comprehensive Distancing

Research suggests that moral disgust, shame, and guilt are present in posttraumatic psychopathology. However, it is unclear that these emotional states are responsive to empirically supported interventions for posttraumatic stress symptoms (PTSS). This study explored the relations among moral disgust, shame, guilt, and PTSS, and examined comprehensive distancing (CD) as a novel intervention for these emotional states in undergraduates with elevated PTSS. Participants were randomly assigned to use a CD or a cognitive challenge task in response to personalized scripts of a traumatic event. Both interventions were associated with decreases in disgust, moral disgust, shame, and guilt. Contrary to predictions, there were no significant differences between the exercises in the reduction of negative emotions. In addition, PTSS severity was correlated with trauma-related guilt as well as state guilt and shame, but not trait or state measures of disgust or moral disgust. This proof of concept project sets the stage for further research examining CD as an alternative or adjunctive intervention for posttraumatic stress reactions with strong features of moral disgust, shame, and guilt.

Lifetime histories of PTSD, suicidal ideation, and suicide attempts in a nationally representative sample of adolescents: Examining indirect effects via the roles of family and peer social support

The prevalence of mental health problems, including suicidal thoughts and behavior, increase during adolescence (Kessler et al., 2007; Nock et al., 2008). In fact, suicide is the second leading cause of death among adolescents, with a prevalence of 4.04 per 100,000 (Centers for Disease Control & Prevention, 2011). The prevalence of suicidal ideation and suicide attempts is even greater, with up to 17% of adolescents reporting having seriously considered attempting suicide and 8% having made a suicide attempt at least once in the past year (Kann et al., 2014). The current study focuses on advancing our understanding of how social support may influence links between psychopathology and suicidal thoughts and behaviors. Risk for suicidal behavior is elevated among adolescents experiencing difficulties with affective states and arousal indicative of mental health disorders (Cash & Bridge, 2009; Rojas, Leen-Feldner, Blumenthal, Lewis, & Feldner, 2015) In fact, the majority of adolescents reporting suicidal ideation or suicide attempts meet lifetime criteria for a mental health disorder (Nock et al., 2013). Among lifetime mental health diagnoses, posttraumatic stress disorder (PTSD) is a robust predictor of suicidal ideation in general (Sareen, Houlahan, Cox, & Asmundson, 2005) and among adolescents in particular (Mazza, 2000; Nock et al., 2013; Waldrop et al., 2007). Approximately 5% of adolescents have met criteria for PTSD at some point in their lives (Merikangas et al., 2010). Given the prevalence of PTSD and its link with suicidal thoughts and behaviors (Bridge, Goldstein, & Brent, 2006; Nock et al., 2013), there is a need to improve our understanding of factors that may shed light on this relation, such as social support. Social support is a key aspect of healthy functioning, and its absence is associated with both increased risk for (Barrett &Mizes, 1988; Grav, Hellzèn, Romild, & Stordal, 2012) and problems recovering from (Beattie & Longabaugh, 1997; Cohen &Wills, 1985; Filipas & Ullman, 2001; Scarpa, Haden, & Hurley, 2006) psychological disorders, including PTSD. Further, symptoms of psychopathology are associated with deteriorations in social support networks, which can in turn contribute to a worsening of symptoms (Hobfoll, 1989; Schnurr, Lunney, & Sengupta, 2004; Vranceanu, Hobfoll, & Johnson, 2007). Indeed, adults with PTSD often report difficulties in social support networks (Dutton, Adams, Bujarski, Badour, & Feldner, 2014; Kaniasty & Norris, 2008) and prospective evidence suggests elevated PTSD symptom severity predicts dysfunctional communication in dyadic relationships, but not vice versa (Fredman et al., 2016). For example, among military Veterans, PTSD relates positively to family adjustment problems following return from deployment (Sayers, Farrow, Ross, & Oslin, 2009). These recent results accord with a burgeoning literature suggesting PTSD among adults may impair important aspects of social support networks (Alderfer, Navsaria, & Kazak, 2009; Gold et al., 2007; Kaniasty & Norris, 2008; Taft et al., 2008Taft, Schumm, Panuzio, & Proctor, 2008). Similarly, elevated posttraumatic stress symptoms (PTSS) are associated with low social support and social withdrawal among adolescents (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012). In fact, children rely on their parents for support more generally and traumatic experiences that disrupt family social networks exacerbate the effects to follow (Pine & Cohen, 2002). In their review of developmental factors conceptualized to influence PTSD among youth, Salmon and Bryant (2000) highlight how familial support may help youth successfully respond to a traumatic event (e.g., supporting adaptive affect regulation, promoting approach-oriented behavior). Consistent with this perspective, among youth between the ages of 8 and 14 years exposed to violence, inadequate social support (i.e., lower levels of mother support) was linked with elevated internalizing-type symptoms (e.g., depression; Kliewer, Lepore, Oskin, & Johnson, 1998). Similarly, in a large sample of adolescents exposed to a natural disaster, Bokszczanin (2008) observed greater distress in the context of low perceived parental support. Indeed, a number of studies suggest trauma-specific symptoms relate negatively to perceptions of social support (Berman, Kurtines, Silverman, & Serafini, 1996). Interestingly,

Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk

Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with ones behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed.

Affective lability predicts decreased habituation in posttraumatic stress symptom responding during a single laboratory session of imaginal exposure

Affective lability, or the instability of emotional states, is associated with heightened levels of trauma-related emotional responding and posttraumatic stress disorder (PTSD) symptoms. However, the impact of affective lability, specifically on habituation to idiographic trauma cues, has yet to be examined among trauma-exposed individuals. The current study examined differential response trajectories to trauma-related imaginal exposure as a function of affective lability. Specifically, 72 women with a history of sexual victimization participated in a laboratory-based study involving a single session of repeated imaginal exposures to idiographic traumatic event cues. As hypothesized, participants higher in affective lability reported less reduction in trauma-cue elicited posttraumatic stress symptoms across exposure trials. Given these results, it will be important to continue to extend these laboratory findings to better understand how elevated affective lability is related to response to trauma-focused exposure therapy among individuals with PTSD or other trauma-related psychopathology (e.g., borderline personality disorder).

A preliminary study of subclinical panic symptom elevations among adolescent offspring of parents with PTSD who smoke

Objectives: Research has linked parental post-traumatic stress disorder (PTSD) and parental smoking to a wide array of psychological and physical health concerns among offspring. Furthermore, the combination of parental anxiety psychopathology generally, along with smoking, has been linked to elevated adolescent panic symptomatology. However, no research has examined the unique and interactive associations between parental PTSD and smoking in terms of offspring panic. Method: The current study sought to begin to address this gap in the literature by examining adolescent-reported panic symptom levels as a function of parent-reported PTSD and current smoking. Results: Among 25 dyads (Mparent age = 42.92 years [SD = 6.71]; Moffspring age = 15.80 years [SD = 1.04]), adolescent offspring of smokers with PTSD reported significantly higher panic symptoms compared with all other combinations of these factors after controlling for multiple theoretically relevant and empirically associated covariates. Supporting model specificity, parental PTSD and smoking were not related to adolescent depression or other types of anxiety. Conclusions: These results are consistent with research linking the combination of parental anxiety psychopathology and smoking to offspring panic generally, and parental PTSD and smoking to panic symptoms specifically. Research on possible mechanisms of intergenerational transmission as well as replication and extension of these findings is now needed.

The Elicitation and Assessment of Emotional Responding

The laboratory study of emotion has led to a strong theoretical understanding of how emotions arise and what occurs at the level of behavior, subjective experience, and physiology throughout the time course of an emotion. In order to elicit emotion, researchers have used a flexible array of visual, auditory, and biological procedures. Further, a vast collection of well-established measures allows for the comprehensive assessment of an emotion once it has been elicited. This chapter provides an overview of emotion-elicitation paradigms, discussing the assessment strategies most commonly used to measure emotions across their time course. We also consider the modification of an elicitation or assessment approach to fit the population of interest, as well as the impact of sleep deprivation on emotion.