An Examination of the Specific Associations Between Facets of Difficulties in Emotion Regulation and Posttraumatic Stress Symptom Clusters
Tóm tắt
Prior research has shown that difficulties in emotion regulation is associated with overall levels of posttraumatic stress symptoms (PTSS). However, it is currently unclear which facets of difficulties in emotion regulation (e.g., lack of emotion regulation strategies, impulse control problems, non-acceptance of emotional responses) are associated with specific PTSS clusters. This information may be valuable in refining treatment approaches in PTSS. The aim of the current study was to use structural equation modeling to test the relationships between Difficulties in Emotion Regulation Scale (DERS) subfactors and PTSS in a trauma-exposed community sample (N = 746). Results indicated that impulse control difficulties were most consistently associated across PTSS clusters (i.e., re-experiencing, avoidance, and hyperarousal), while lack of emotion regulation strategies and emotional clarity were uniquely associated with numbing symptoms, after covarying for neuroticism. However, other facets of difficulties in emotion regulation (i.e., non-acceptance of emotional responses and difficulties engaging in goal-directed behavior while upset) were not associated with PTSS. These findings provide further support for the role of difficulties in emotion regulation in specific PTSS clusters. Additionally, they suggest that impulse control problems may be important in the development of most PTSS and thus most beneficial to target clinically, while lack of emotional clarity and effective emotion regulation strategies may be specific to numbing symptoms.
Tài liệu tham khảo
Asmundson, G. J., Frombach, I., McQuaid, J., Pedrelli, P., Lenox, R., & Stein, M. B. (2000). Dimensionality of posttraumatic stress symptoms: A confirmatory factor analysis of DSM-IV symptom clusters and other symptom models. Behaviour Research and Therapy, 38, 203–214. doi:10.1016/S0005-7967(99)00061-3.
Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2012). An examination of the latent structure of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 34(3), 382–392. doi:10.1007/s10862-012-9280-y.
Bardeen, J. R., Kumpula, M. J., & Orcutt, H. K. (2013). Emotion regulation difficulties as a prospective predictor of posttraumatic stress symptoms following a mass shooting. Journal of Anxiety Disorders, 27(2), 188–196. doi:10.1016/j.janxdis.2013.01.003.
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246. doi:10.1037/0033-2909.107.2.238.
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavior Research and Therapy, 34(8), 669–673. doi:10.1016/0005-7967(96)00033-2.
Bonn-Miller, M. O., Vujanovic, A. A., Boden, M. T., & Gross, J. J. (2011). Posttraumatic stress, difficulties in emotion regulation, and coping-oriented marijuana use. Cognitive Behaviour Therapy, 40(1), 34–44. doi:10.1080/16506073.2010.525253.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (Vol. 154). Newbury Park, CA: Sage Publications.
Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon’s Mechanical Turk a new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science, 6(1), 3–5. doi:10.1177/1745691610393980.
Chard, K. M., Schumm, J. A., McIlvain, S. M., Bailey, G. W., & Parkinson, R. B. (2011). Exploring the efficacy of a residential treatment program incorporating cognitive processing therapy-cognitive for veterans with PTSD and traumatic brain injury. Journal of Traumatic Stress, 24(3), 347–351. doi:10.1002/jts.20644.
Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: An integrative review. Journal of Psychopathology and Behavioral Assessment, 32, 68–82. doi:10.1007/s10862-009-9161-1.
Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067–1074. doi:10.1037/0022-006X.70.5.1067.
Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1(1), 16.
Dewey, D., Schuldberg, D., & Madathil, R. (2014). Do peritraumatic emotions differentially predict PTSD symptom clusters? Initial evidence for emotion specificity. Psychological Reports, 115(1), 1–12. doi:10.2466/16.02.PR0.115c11z7.
Ehring, T., Fischer, S., Schnülle, J., Bösterling, A., & Tuschen-Caffier, B. (2008). Characteristics of emotion regulation in recovered depressed versus never depressed individuals. Personality and Individual Differences, 44(7), 1574–1584. doi:10.1016/j.paid.2008.01.013.
Fairholme, C. P., Nosen, E. L., Nillni, Y. I., Schumacher, J. A., Tull, M. T., & Coffey, S. F. (2013). Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample. Behaviour Research and Therapy, 51(9), 540–546. doi:10.1016/j.brat.2013.05.014.
Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment, 9(4), 445–451. doi:10.1037/1040-3590.9.4.445.
Foa, E. B., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide. Oxford: Oxford University Press. doi:10.1093/med:psych/9780195308501.001.0001.
Galatzer-Levy, I. R., & Bryant, R. A. (2013). 636,120 ways to have post-traumatic stress disorder. Perspectives on Psychological Science, 8(6), 651–662. doi:10.1177/1745691613504115.
Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy, 37(1), 25–35. doi:10.1016/j.beth.2005.03.002.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. doi:10.1023/B:JOBA.0000007455.08539.94.
Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115(4), 850–855. doi:10.1037/0021-843X.115.4.850.
Gross, J. J., & Levenson, R. W. (1993). Emotional suppression: Physiology, self-report, and expressive behavior. Journal of Personality and Social Psychology, 64, 970–986. doi:10.1037/0022-3514.64.6.970.
Hoge, C. W., Riviere, L. A., Wilk, J. E., Herrell, R. K., & Weathers, F. W. (2014). The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: A head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist. The Lancet Psychiatry, 1(4), 269–277. doi:10.1016/S2215-0366(14)70235-4.
Hom, M. A., Stanley, I. H., Rogers, M. L., Tzoneva, M., Bernert, R. A., & Joiner, T. E. (2015). The association between sleep disturbances and depression among firefighters: Emotion dysregulation as an explanatory factor. Journal of Clinical Sleep Medicine, 12(2), 235–245.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. doi:10.1080/10705519909540118.
John, O. P., Donahue, E. M., & Kentle, R. L. (1991). The big five inventory—Versions 4a and 54. Berkeley: University of California, Berkeley, Institute of Personality and Social Research.
John, O. P., & Srivastava, S. (1999). The big five trait taxonomy: History, measurement, and theoretical perspectives. Handbook of personality: Theory and Research, 2(1999), 102–138.
Kessler, R. C. (2000). Posttraumatic stress disorder: The burden to the individual and to society. Journal of Clinical Psychiatry, 61(S5), 4–12.
King, D., Leskin, G., King, L., & Weathers, F. (1998). Confirmatory factor analysis of the Clinician-Administered PTSD Scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10, 90–96. doi:10.1037/1040-3590.10.2.90.
Loncar, M., Plasc, I. D., Bunjevac, T., Hrabac, P., Jaksic, N., Kozina, S., & Marcinko, D. (2014). Predicting symptom clusters of posttraumatic stress disorder (PTSD) in Croatian war veterans: the role of socio-demographics, war experiences and subjective quality of life. Psychiatria Danubina, 26, 231–238.
Moshagen, M. (2012). The model size effect in SEM: Inflated goodness-of-fit statistics are due to the size of the covariance matrix. Structural Equation Modeling: A Multidisciplinary Journal, 19(1), 86–98. doi:10.1080/10705511.2012.634724.
Mulaik, S. (2007). There is a place for approximate fit in structural equation modelling. Personality and Individual Differences, 42(5), 883–891. doi:10.1016/j.paid.2006.10.024.
Muthén, B. O., & Muthén, P. K. (1998–2012). Mplus user’s guide (Vol. 7th Edition). Muthen & Muthen: Los Angeles, CA.
O’Bryan, E. M., McLeish, A. C., Kraemer, K. M., & Fleming, J. B. (2015). Emotion regulation difficulties and posttraumatic stress disorder symptom cluster severity among trauma-exposed college students. Psychological Trauma: Theory, Research, Practice, and Policy, 7(2), 131–137. doi:10.1037/a0037764.
Palmieri, P. A., & Fitzgerald, L. F. (2005). Confirmatory factor analysis of posttraumatic stress symptoms in sexually harassed women. Journal of Traumatic Stress, 18, 657–666. doi:10.1002/jts.20074.
Paolacci, G., & Chandler, J. (2014). Inside the turk understanding mechanical turk as a participant pool. Current Directions in Psychological Science, 23(3), 184–188. doi:10.1177/0963721414531598.
Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5(3), 455–475. doi:10.1002/jts.2490050309.
Schell, T. L., Marshall, G. N., & Jaycox, L. H. (2004). All symptoms are not created equal: The prominent role of hyperarousal in the natural course of posttraumatic psychological distress. Journal of Abnormal Psychology, 113, 189–197. doi:10.1037/0021-843X.113.2.189.
Seligowski, A. V., Lee, D. J., Bardeen, J. R., & Orcutt, H. K. (2015). Emotion regulation and posttraumatic stress symptoms: A meta-analysis. Cognitive Behavior Therapy, 44(2), 87–102. doi:10.1080/16506073.2014.980753.
Short, N. A., Oglesby, M. E., Raines, A. M., Zvolensky, M. J., & Schmidt, N. B. (2015). Posttraumatic stress and emotion dysregulation: Relationships with smoking to reduce negative affect and barriers to smoking cessation. Comprehensive Psychiatry, 61, 15–22. doi:10.1016/j.comppsych.2015.05.007.
Short, N. A., Raines, A. M., Oglesby, M. E., Zvolensky, M. J., & Schmidt, N. B. (2014). Insomnia and emotion dysregulation: Independent and interactive associations with posttraumatic stress symptoms among trauma-exposed smokers. Journal of Affective Disorders, 165, 159–165. doi:10.1016/j.jad.2014.04.069.
Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology, 111, 637–647. doi:10.1037/0021-843X.111.4.637.
Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011). Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: A pilot study of an intensive residential treatment program. Journal of Traumatic Stress, 24(1), 102–106. doi:10.1002/jts.20617.
Tull, M. T., Barrett, H. M., McMillan, E. S., & Roemer, L. (2007). A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy, 38(3), 303–313. doi:10.1016/j.beth.2006.10.001.
Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. In Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.
Weiss, N. H., Tull, M. T., Viana, A. G., Anestis, M. D., & Gratz, K. L. (2012). Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. Journal of Anxiety Disorders, 26, 453–458. doi:10.1016/j.janxdis.2012.01.007.
Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28(7), 596–606. doi:10.1002/da.20837.