Understanding Anger and Psychosocial Functioning in a Sample of Post-9/11 Veterans Using Ecological Momentary Assessment

Anger is an important aspect of the negative emotion associated with posttraumatic stress disorder (PTSD), and difficulties with anger regulation are implicated in more severe PTSD trajectories as well as associated problems such as aggression perpetration. Anger is also known to erode social relationships and is implicated in poorer psychosocial functioning and having fewer close relationships. From a diagnostic conceptualization, anger is included in both the hyperarousal symptom cluster (e.g. irritability and angry reactions) and the negative alterations in cognitions and mood symptom cluster (e.g. negative emotions like anger, fear, shame, etc). Although anger is included in the diagnostic symptoms of PTSD, it is not often a specific focus of research and there are few investigations of anger on a granular level. This study assessed anger and psychosocial functioning in a sample of post-9/11 veterans with PTSD (N = 70; 87.1% cisgender men; 60.0% white, 32.9% African American/Black; Mage = 37.6 years [SD = 7.8]) using ecological momentary assessment (EMA) to capture daily reports of anger frequency and intensity. Hierarchical and simple linear regressions were used to investigate between-subjects relations among PTSD symptoms, anger reported via EMA, and indices of psychosocial functioning. Primary results from this study demonstrated that anger reported via EMA significantly predicted greater impairment in some domains of psychosocial functioning, after controlling for PTSD symptom severity. Findings from this study suggest that the frequency and intensity of experiences of anger in veteran’s day-to-day lives may contribute to psychosocial functioning impairment beyond the expected deleterious impact of PTSD. A nuanced measurement of anger may have clinical utility in predicting psychosocial functioning among veterans with PTSD

Posttraumatic stress disorder and aggression among post-9/11 veterans: The role of shame

Posttraumatic stress disorder (PTSD) is often accompanied by elevated aggression. PTSD and combat exposure alone do not fully explain the reliable finding of heightened aggression among trauma-exposed veterans. Shame may be an important affective feature in this relationship. The present study examined the role of shame from a social hierarchy theoretical perspective in a sample of 52 combat veterans from the post-9/11 era. Correlational analyses indicated moderately strong positive relationships among PTSD, shame, and aggression. Trait shame was found to significantly mediate the relationship between total PTSD severity and physical aggression, but not other forms of aggression. For veterans within the context of a hierarchical military culture, separation from the military and PTSD diagnosis may be very salient markers of social loss and social exclusion. Aggression may operate to reduce the negative affective experience associated with shame and to regain social standing. Findings implicate shame as an important emotional component in the relationship between PTSD and aggression

Use of Ecological Momentary Assessment and Intervention in Treatment With Adults

This article reviews the use of ecological momentary assessment (EMA) and ecological momentary intervention (EMI) in clinical research applications. EMA refers to a method of data collection that attempts to capture respondents\u27 activities, emotions, and thoughts in the moment, in their natural environment. It typically uses prompts administered through a personal electronic device, such as a smartphone or tablet. EMI extends this technique and includes the use of microlevel interventions administered through personal electronic devices. These technological developments hold promise for enhancing psychological treatments by prompting the patient outside of therapy sessions in his or her day-to-day environment. Research suggests that EMI may be beneficial to participants and that this effect is amplified when EMI is delivered in the context of ongoing psychotherapy. EMI may reflect a cost-effective mechanism to enhance therapeutic outcomes

Using Latent Variable Mixture Modeling to Understand Trauma-Related Outcomes in Undergraduate Women

Posttraumatic stress disorder (PTSD) and sexual functioning problems often co-occur after trauma. Researchers have linked certain factors (e.g., depression, relationship satisfaction) to PTSD and sexual functioning, but it is unclear how these variables interact. Adult undergraduate female trauma survivors (N = 280) completed self-report measures via an online survey. Latent variable mixture modeling generated four groups that differed in terms of their PTSD symptom severity, sexual functioning, sexual pain, relationship status, and relationship functioning. ANOVAs explored group differences. Classes were not differentiated by trauma, relationship satisfaction, or drug use. Results highlight the complex relations between sexual functioning and post-trauma symptomology

Using a Person-Centered Approach to Identify Patterns of Exposure to Intimate Partner Violence and Child Abuse in Women: Associations With Mental Health

Patterns of exposure to intimate partner violence (IPV) and child abuse (CA) were explored in 467 women seeking psychological assistance following IPV. Using latent class analysis, three classes were obtained: women who had experienced physical, sexual, and psychological IPV, along with childhood physical and sexual abuse (IPV + CA; 38.5%); women who had experienced physical, sexual, and psychological IPV only (IPV/no CA; 52.9%); and women who had experienced psychological IPV only (Psych IPV only; 8.6%). Associations of class membership with severity of specific mental health conditions were examined, along with the number of diagnosed conditions. Significant between-class differences were noted on severity of IPV-related posttraumatic stress disorder, depressive disorders, alcohol and substance use disorders, and social phobia. Classes also differed significantly on the number of mental health conditions. Understanding patterns of betrayal-based trauma (e.g., IPV and CA) can inform care within agencies that serve IPV survivors by highlighting individuals at-risk for mental health conditions

Open trial of a personalized feedback intervention and substance-free activity supplement for veterans with PTSD and hazardous drinking

This study reports findings from an open trial of a two-session intervention for veterans with symptoms of PTSD and hazardous drinking. Rooted behavioral economic theory, this intervention aimed to decrease alcohol use and increase alcohol-free activities through personalized and normative feedback. This trial assessed the feasibility and acceptability of the intervention in a sample of 15 veterans. Participants completed assessments at baseline and post-intervention (1-month and 3-months). Thirteen participants (86.6%) were retained between the baseline assessment and second intervention session. Acceptability data indicated that veterans overwhelmingly viewed the intervention positively with little dropout between the two sessions. Further, participants in our study reduced alcohol consumption from 37.30 (SD = 17.30) drinks per week at baseline to 22.50 (SD = 27.75) drinks per week at the 1-month assessment and then to 14.60 (SD = 18.64) at the 3-months assessment, representing medium to large effects. PTSD severity also decreased from 57.20 (SD = 16.72) at baseline to 48.90 (SD = 18.99) at the 1-month assessment, representing a small effect. Though effect sizes from pilot trials should be interpreted with caution, findings suggest that this intervention was well-received, feasible to deliver, and may have resulted in improvements in intervention targets

Relations Among Meaning Making, PTSD, and Complicated Grief Following Homicide Loss

Survivors of homicide loss are vulnerable to negative mental health outcomes, including posttraumatic stress disorder (PTSD) and complicated grief (CG). Meaning making in the aftermath of traumatic loss is hypothesized to be an adaptive process associated with reduced symptomatology. Homicide survivors (N = 57) completed the PTSD Checklist, Inventory of Complicated Grief–Revised, and Grief and Meaning Reconstruction Inventory (GMRI). Correlations were found between the GMRI Emptiness and Meaninglessness subscale and both PTSD and CG symptom severity. Results lend support to the notion that reduced meaning making is particularly salient to the expression of PTSD and CG among homicide survivors

Alcohol use and coping in a cross-sectional study of African American homicide survivors

The loss of a loved one to homicide is associated with considerable distress, often in the form of posttraumatic stress disorder (PTSD) and complicated grief (CG), and alcohol misuse. Yet alcohol-related problems and loss from a homicide are issues that disproportionally affect African Americans. The present study investigated alcohol use in a sample of 54 African American homicide survivors. Although there was a low prevalence of hazardous drinking, alcohol use was associated with higher levels of PTSD, complicated grief, and depression severity. In addition, scores on the Alcohol Use Disorders Identification Test (AUDIT) were correlated with active emotional coping and avoidant emotional coping. In analyses of PTSD symptom clusters, emotional numbing and hyperarousal symptoms were significantly correlated with AUDIT total score

The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model

The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operant conditioning. In the behavioral economic framework of PTSD, negatively reinforced avoidance behavior is overvalued, in part due to deficits in environmental reward, and may be conceptualized as a form of reinforcer pathology (i.e., excessive preference for and valuation of an immediate reinforcer). We investigated cross-sectional relationships between PTSD severity and several constructs rooted in this behavioral economic framework, including future orientation, reward availability, and delay discounting in a sample of 110 military personnel/veterans (87.2% male) who had served combat deployments following September 11, 2001. Total PTSD severity was inversely related to environmental reward availability, β = -.49, ΔR = 0.24, p \u3c .001; hedonic reward availability, β = -.32, ΔR = 0.10, p = .001; and future orientation, β = -.20, ΔR = 0.04, p = .032, but not delay discounting, r = -.05, p = .633. An examination of individual symptom clusters did not suggest that avoidance symptoms were uniquely associated with these behavioral economic constructs. The findings offer support for a behavioral economic model of PTSD in which there is a lack of positive reinforcement as well as a myopic focus on the present