Lori A. Zoellner

Are expressive suppression and cognitive reappraisal associated with stress-related symptoms?

Emotion dysregulation is thought to be critical to the development of negative psychological outcomes. Gross (1998b) conceptualized the timing of regulation strategies as key to this relationship, with response-focused strategies, such as expressive suppression, as less effective and more detrimental compared to antecedent-focused ones, such as cognitive reappraisal. In the current study, we examined the relationship between reappraisal and expressive suppression and measures of psychopathology, particularly for stress-related reactions, in both undergraduate and trauma-exposed community samples of women. Generally, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms. In particular, expressive suppression was associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, with rumination partially mediating this association. Finally, based on factor analysis, expressive suppression and cognitive reappraisal appear to be independent constructs. Overall, expressive suppression, much more so than cognitive reappraisal, may play an important role in the experience of stress-related symptoms. Further, given their independence, there are potentially relevant clinical implications, as interventions that shift one of these emotion regulation strategies may not lead to changes in the other.

Overgeneral Autobiographical Memory and Traumatic Events: An Evaluative Review.

Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology.

Exploring the roles of emotional numbing, depression, and dissociation in PTSD.

Some researchers consider emotional numbing a cardinal feature of posttraumatic stress disorder (PTSD). Others view numbing symptoms as representing an overlap between PTSD, depression, and dissociation. In this study, we examined the ability of early emotional numbing, depression, and dissociation symptoms to predict PTSD. One-hundred sixty-one women who were recent victims of sexual or nonsexual assault were assessed prospectively for 12 weeks. Emotional numbing, depression, and dissociation were each associated with initial PTSD severity. Notably, regression analyses revealed that after depression and dissociation were accounted for, early numbing contributed to the prediction of later PTSD.

Changes in Comorbid Conditions After Prolonged Exposure for PTSD: a Literature Review

Prolonged exposure (PE) is an effective psychological treatment for patients who suffer from PTSD. The majority of PTSD patients have comorbid psychiatric disorders, and some clinicians are hesitant to use PE with comorbid patients because they believe that comorbid conditions may worsen during PE. In this article, we reviewed the evidence for this question: what are the effects of PE on comorbid symptoms and associated symptomatic features? We reviewed findings from 18 randomized controlled trials of PE that assessed the most common comorbid conditions (major depression, anxiety disorders, substance use disorders, personality disorders, and psychotic disorders) and additional symptomatic features (suicidality, dissociation, negative cognitions, negative emotions, and general health and work/social functioning). Although systematic research is not available for all comorbid populations, the existing research indicates that comorbid disorders and additional symptomatic features either decline along with the PTSD symptoms or do not change as a result of PE. Therefore, among the populations that have been studied to date, there is no empirical basis for excluding PTSD patients from PE due to fear of increases in comorbid conditions or additional symptomatic features. Limitations of the existing research and recommendations for future research are also discussed.

Anger, dissociation, and posttraumatic stress disorder among female assault victims

The goal of the present study was to explore the relationship between anger and dissociation and their relationship to symptoms of posttrauma pathology. One hundred four female assault victims were assessed prospectively 2, 4, and 12 weeks postassault. Measures of posttraumatic stress disorder (PTSD) severity, social functioning, anger, and dissociation were obtained at all assessments. Results revealed that differentiation between symptoms that predict later PTSD and impaired social functioning first becomes evident at 4 weeks postassault. At 4 weeks postassault, anger expression was predictive of later PTSD severity, whereas dissociation was predictive of poorer later functioning.

Psychological and Environmental Factors Associated with Partner Violence

This article presents a brief summary of the literature on variables associated with cessation or continuation of partner violence with the aim of generating two conceptual models: psychological and environmental. Toward this goal, the authors first examine existing theoretical models of womens influence on partner violence. Second, they review psychological and environmental variables associated with womens influence on partner violence. To capture the richness and complexity of factors involved in partner violence, the two models include multifaceted constructs such as psychological difficulties, resilience, and partner violence. The conceptual models are designed to provide a framework for developing research that will enhance the understanding about womens influence on the course of partner violence and, in turn, will inform interventions aimed at helping women reduce violence in their lives.

PTSD severity and health perceptions in female victims of sexual assault

In women with chronic posttraumatic stress disorder (PTSD), poor physical health may be related to their PTSD symptoms through an underlying negative affect or distress that accompanies the disorder, through the PTSD symptoms in general, or specifically through the chronic hyperarousal present in the disorder. The current study examined the relative contribution of these factors to reported physical symptoms in female victims of sexual assault. Seventy-six women with chronic PTSD were assessed, using measures of stressful life events, psychological difficulties, and perceived health. Negative life events, anger, depression, and PTSD severity were all related to self-reported physical symptoms; however, PTSD severity predicted self-reported physical symptoms beyond these other variables. Contrary to our hypothesis, the reexperiencing cluster of PTSD, and not the hyperarousal cluster, was related to self-reported physical symptoms.

Examining potential contraindications for prolonged exposure therapy for PTSD

Although prolonged exposure (PE) has received the most empirical support of any treatment for post-traumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems.

Treatment Compliance and Outcome in Obsessive-Compulsive Disorder:

Exposure and ritual prevention (EX/RP) is an effective treatment for obsessive compulsive disorder (OCD), although it is neither universally nor completely helpful. Compliance with EX/RP treatment procedures has been linked theoretically to posttreatment outcome, yet empirical exploration of this relationship has been insufficient. In this study, therapists were asked to rate the treatment compliance of 28 consecutive patients who received EX/RP on a fee-for-service basis. Results indicated that understanding the treatment rationale and compliance with insession and homework exposure instructions, but not with ritual prevention and self-monitoring of rituals, was significantly related to posttreatment OCD symptom severity. Clinical implications of these findings and future directions in treatment compliance research with OCD patients are discussed.

Patterns of emotion regulation and psychopathology

Abstract Emotion regulatory strategies such as higher expressive suppression and lower cognitive reappraisal may be associated with increased psychopathology (Gross & John, 2003). Yet, it is unclear whether these strategies represent distinct cognitive styles associated with psychopathology, such that there are individuals who are predominantly “suppressors” or “reappraisers.” Using cluster analysis, we examined whether women with and without exposure to potentially traumatic events evidence distinct patterns of emotion regulation frequency, capacity, suppression, and cognitive reappraisal. Four patterns emerged: high regulators; high reappraisers/low suppressors; moderate reappraisers/low suppressors; and low regulators. Individuals who reported infrequently and ineffectively regulating their emotions (low regulators) also reported higher depression, anxiety, and posttraumatic stress disorder (PTSD). In contrast, individuals who reported frequently and effectively using reappraisal and low levels of suppression (high reappraisers/low suppressors) reported the lowest levels of these symptoms, suggesting that this specific combination of emotion regulation may be most adaptive. Our findings highlight that the capacity to regulate emotions and the ability to flexibly apply different strategies based on the context and timing may be associated with reduced psychopathology and more adaptive functioning.