Lisa S. Elwood

The Disgust Scale: Item Analysis, Factor Structure, and Suggestions for Refinement.

In the 4 studies presented (N = 1,939), a converging set of analyses was conducted to evaluate the item adequacy, factor structure, reliability, and validity of the Disgust Scale (DS; J. Haidt, C. McCauley, & P. Rozin, 1994). The results suggest that 7 items (i.e., Items 2, 7, 8, 21, 23, 24, and 25) should be considered for removal from the DS. Secondary to removing the items, exploratory and confirmatory factor analyses revealed that the DS taps 3 dimensions of disgust: Core Disgust, Animal Reminder Disgust, and Contamination-Based Disgust. Women scored higher than men on the 3 disgust dimensions. Structural modeling provided support for the specificity of the 3-factor model, as Core Disgust and Contamination-Based Disgust were significantly predictive of obsessive- compulsive disorder (OCD) concerns, whereas Animal Reminder Disgust was not. Results from a clinical sample indicated that patients with OCD washing concerns scored significantly higher than patients with OCD without washing concerns on both Core Disgust and Contamination-Based Disgust, but not on Animal Reminder Disgust. These findings are discussed in the context of the refinement of the DS to promote a more psychometrically sound assessment of disgust sensitivity.

Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model.

While some individuals develop PTSD subsequent to traumatic experiences, many individuals resume prior functioning naturally. Diathesis-stress models suggest that stable individual differences present in individuals prior to trauma may serve as vulnerability factors to symptom development. The high levels of comorbidity and symptom similarity suggest that established vulnerability factors for anxiety and depression may also serve as vulnerability factors for PTSD. The examination of multiple vulnerability factors simultaneously may increase understanding of the etiology of PTSD and comorbid post-trauma symptomatology and account for a greater percentage of variance in PTSD symptoms. In addition, the vulnerability factors may be related to distinct sets of symptoms, with vulnerabilities predicting the PTSD symptoms most similar to their associated disorders. Research examining the relations between attributional style, rumination, anxiety sensitivity, and the looming cognitive style and the development of PTSD after trauma exposure is reviewed and suggestions for future research are provided.

Measurement of anxious traits: a contemporary review and synthesis

Abstract Trait anxiety is a characteristic predisposition to appraise stimuli as threatening and respond with anxiety. Trait anxiety is proposed to serve as a vulnerability factor for greater frequency and intensity of anxiety experiences as well as the development of anxious pathology. Cognitive, behavioral, and physiological components of trait anxiety have been described. Common self-report measures of trait anxiety are reviewed with an emphasis on: components assessed, factor structure, internal consistency, reliability, and construct validity. Measures were selected if instructions ask individuals to endorse items based on their characteristic, rather than a time sensitive, response. Selection criteria resulted in a focus on the following measures: the State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory-Trait (BAIT), Cognitive Somatic Anxiety Questionnaire (CSAQ), Endler Multidimensional Anxiety Scales-Trait (EMAS-T), Four Systems Anxiety Questionnaire (FSAQ), State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), and the Three Systems Anxiety Questionnaire (TSAQ). While the STAI has the advantage of normative data and frequent use in prior research, newer measures, such as the BAIT and the STICSA, demonstrate greater discriminant validity. The strengths and weaknesses of each of the reviewed measures are highlighted. Recommendations for measure selection and future research are provided.

Mental pollution and PTSD symptoms in victims of sexual assault: A preliminary examination of the mediating role of trauma-related cognitions.

Trauma-related cognitions have been proposed to contribute significantly to posttraumatic stress disorder (PTSD) symptoms. Recent research suggests that feelings of mental pollution (feelings of dirtiness without physical contact) may also contribute to symptoms of PTSD in victims of sexual assault (Fairbrother & Rachman, 2004). The present study investigated the relation between mental pollution, PTSD cognitions, and PTSD symptoms in victims of sexual assault (N = 48). The results indicated that mental pollution was significantly related to PTSD symptoms even when statistically controlling for symptoms of anxiety and depression. However, subsequent analyses showed that the relation between feelings of mental pollution and PTSD symptoms was fully mediated by trauma-related cognitions. These findings are discussed in the context of a model in which feelings of mental pollution elicit specific negative cognitions that maintain PTSD symptoms in victims of sexual assault.

Attributional style and anxiety sensitivity as maintenance factors of posttraumatic stress symptoms: A prospective examination of a diathesis-stress model.

Diathesis-stress models of posttraumatic stress disorder (PTSD) assert that traumatic events function as stressors that interact with vulnerabilities to influence the development of PTSD. The present study prospectively examined negative attributional style (NAS) and anxiety sensitivity (AS) as maintenance factors for PTSD in female adult sexual assault victims. A diathesis-stress model was tested by examining interactions between the vulnerabilities and negative life events. The present study included both the traditional three-factor model of PTSD (re-experiencing, avoidance and emotional numbing, and arousal) and the dysphoria four-factor model of PTSD (re-experiencing, avoidance, arousal, and dysphoria). Robust regression analyses revealed that negative life events at Time 2 significantly predicted increases in all clusters of the three-factor model (i.e., re-experiencing, avoidance and numbing, and arousal) and the re-experiencing, arousal, and dysphoria clusters of the four-factor model (but not avoidance). Neither NAS nor AS significantly independently predicted any of the symptom clusters for either model. Both NAS and AS interacted with negative life events to predict increases in the avoidance and numbing symptoms. However, examination of the dysphoria four-factor model of PTSD revealed that the NAS and AS interactions with negative life events only predicted dysphoria symptoms.

Predictors of rape: findings from the National Survey of Adolescents.

The current report examines data for 872 female adolescents obtained during the initial and follow-up interviews of the National Survey of Adolescents, a nationally representative sample. Lifetime prevalence of violence exposure reported was 12% and 13% for sexual assault, 19% and 10% for physical assault/punishment, and 33% and 26% for witnessing violence at Waves I and II, respectively. Racial/ethnic status, posttraumatic stress disorder (PTSD), childhood sexual abuse (CSA), and family drug problems emerged as significant predictors of new rape. Each of the PTSD symptom clusters significantly predicted new rape and analyses supported the mediational role of PTSD between CSA and new rape. African American or other racial identity was associated with lower risk.

Predictors of physical assault victimization: Findings from the National Survey of Adolescents

Exposure to interpersonal victimization during childhood and adolescence is prevalent and has been found to be associated with negative physical and mental health outcomes. The present study examined the relations between childhood violence exposure and mental health on subsequent exposure to new physical assault in young adults using longitudinal nationally representative, prospective data from the initial (Wave I) and follow-up interviews (Wave II) of the National Survey of Adolescents (NSA). Among the 1,753 participants who completed both assessment time points, 15.8% reported a new physical assault experience at Wave II. Results indicated that racial/ethnic status, gender, history of child physical abuse, witnessed violence drug use, and family drug problems reported at Wave I were all significant predictors of new physical assault. Implications are discussed.

Looming Vulnerability: Incremental Validity of a Fearful Cognitive Distortion in Contamination Fears

Looming vulnerability is a cognitive vulnerability for anxiety syndromes that pertains to a tendency to construct dynamic expectations (i.e., mental scenarios) of negative events as progressively increasing in danger and rapidly escalating in risk. The present study tested the hypothesis that looming vulnerability to contamination (i.e., looming of contamination) and generalized looming vulnerability would be positively related to contamination fears commonly observed in obsessive compulsive disorder (OCD) even when controlling for other vulnerabilities such as negative affectivity, anxiety sensitivity, and appraisals of potential for harm. The results support the predictions that both generalized looming vulnerability and looming of contamination are independently associated with contamination fears. Examination of the specificity of the ‘growing’ and ‘spreading’ aspects of contamination looming revealed that these components did not independently predict contamination fears beyond the additional vulnerabilities, supporting the consideration of a total looming of contamination construct rather than independent examination of its components. The implications of these findings for the conceptualization and treatment of contamination-based OCD are discussed.

Augmenting cognitive processing therapy to improve sleep impairment in PTSD: A randomized controlled trial

OBJECTIVE Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory after treatment. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy [CPT]). METHOD Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. RESULTS After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. CONCLUSION Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. (PsycINFO Database Record

Risk and Protective Factors for Posttraumatic Stress Disorder, Prolonged Grief, and Depression in Survivors of the Violent Death of a Loved One

The violent death of a loved one leaves survivors at increased risk for a host of negative outcomes, including posttraumatic stress disorder, depression, and intense or prolonged grief. In the wake of increased interest in the phenomenology and course of these responses, there has been a corresponding interest in identifying specific predictors of psychological outcomes among survivors. However, most reviewers have focused primarily on predictors located within the individual survivor, such as coping style and trauma history. Externally located variables are equally important in identifying individuals at risk but have been relatively neglected in the literature. We review the three best-studied external predictor variables: cause of death, relationship of the mourner to the deceased, and social support. For each of these variables, we critically examine studies investigating its relationship to outcomes of violent death survivorship, offer conclusions based on available data, and suggest future directions for research.