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Encoding and retrieval difficulties, and avoidance of both traumatic and positive memories, are associated with posttraumatic stress disorder (PTSD) symptoms. However, most PTSD research and clinical work has solely examined the role of traumatic memories in the maintenance/resolution of PTSD symptoms. This review provides a comprehensive discussion of the literature on positive memories and PTSD. First, we review theories and evidence on the relations between trauma, PTSD, and memory processes (particularly positive memories). Next, we propose a conceptual model that integrates evidence from experimental and positive/memory-based intervention research and highlights hypothesized mechanisms underlying the potential effectiveness of targeting positive memories in PTSD interventions. Specifically, we discuss how targeting positive memories could (1) increase positive affect and reduce negative affect, (2) correct negative cognitions, (3) increase specificity of retrieving autobiographical memories, and (4) be effectively integrated/sequenced with and enhance the effects of trauma-focused interventions. Lastly, we suggest clinical research avenues for investigating the relations between positive memories and PTSD, to possibly alter the current PTSD intervention paradigm focused only on traumatic memories. Overall, our proposed model drawing from experimental and intervention research, and outlining potential effects of targeting positive memories to reduce PTSD severity, needs further empirical investigation.

Objective Childhood maltreatment is an increasingly established predictor of psychological problems. However, limited research addresses pathways though which childhood maltreatment influences the mental health of military personnel following deployment. The current study investigated the direct, and indirect through emotional numbing, relations between childhood maltreatment and psychological distress of recently deployed veterans. Method For a sample of 131 predominantly White, male Operation Iraqi Freedom/Operation Enduring Freedom members of U.S. Army National Guard and Reserve units, a path model was used to test the direct and indirect (through numbing) roles of childhood maltreatment on distress. Results Results showed that childhood maltreatment was not significantly directly associated with psychological distress one-year post-deployment but was indirectly related to distress by way of emotional numbing symptoms. Conclusions Our findings suggest that childhood maltreatment may serve to influence returning veterans' experiences of psychological distress indirectly through increased emotional numbing following deployment. The importance of attending to emotional numbing symptoms among veterans with experiences of childhood maltreatment after deployment is highlighted. (PsycINFO Database Record

To investigate the effect of the count of traumatizing event (TE) types on post-trauma mental health, several studies have compared posttraumatic stress disorder (PTSD) severity between individuals experiencing one versus multiple TE types. However, the validity of these studies depends on the establishment of measurement invariance of the construct(s) of interest. The current study examined the stability of the most optimal PTSD Model symptom cluster constructs (assessed by the PTSD Checklist for DSM-5 [PCL-5]) across subgroups experiencing one versus multiple TE types. The sample included university students (n = 556) endorsing at least one TE (Stressful Life Events Screening Questionnaire). Using data from the entire sample, results suggest that the PCL-5-assessed Hybrid Model provided a significantly better fit compared to other models. Results also indicated invariance of factor loadings (metric), and intercepts (scalar) for the PCL-5-assessed Hybrid Model factors across subgroups endorsing one (n = 191) versus multiple TE types (n = 365). Our findings thus support the stability, applicability, and meaningful comparison of the PCL-assessed Hybrid Model factor structure (including subscale severity scores) across subgroups experiencing one versus multiple TE types.

The experience of potentially traumatizing events (PTEs) may be associated with conflicting outcomes: individuals may experience greater psychological distress (dose-response theory), or individuals may become more resilient against repeated PTEs (stress-inoculation theory). With limited empirical data comparing these theories, we examined the relationships between the count of lifetime PTE types and psychological outcomes [posttraumatic stress disorder (PTSD), depression, impaired distress tolerance] using linear and quadratic regressions. A linear relationship would support the dose-response theory, and a quadratic relationship would support the stress-inoculation theory. We also explored whether there was a threshold number of PTE types fostering resiliency before an increase of distressing outcomes. The sample included 123 (68.30% female) treatment-seeking patients at a community mental health center participating in a larger study (Contractor et al. in Psychiatry Research, 252, 252215–252222, 2017). Linear regression results indicated number of PTE types significantly predicted increasing PTSD and depression severity and distress tolerance difficulties. Quadratic regression model results were not significant. ROC analyses indicated exposure to at least 3.5 PTE types predicted PTSD with moderate accuracy. In conclusion, the dose-response theory was supported, with results indicating there may be a threshold count of lifetime PTE types (> 3) influencing traumatic stress outcomes.

Numerous studies have reported that adverse childhood experiences (ACEs) are associated with negative psychosocial outcomes in adulthood, but no study has examined the different typologies of ACEs and the relationship of these with adult incarceration in military veterans. The current study used latent class analysis to examine the existence of different childhood maltreatment and household dysfunction typologies in a sample of U.S. military veterans identified through the National Epidemiological Survey on Alcohol and Related Conditions-III ((NESARC-III)). A total of 60.73% of veterans reported one or more ACEs. Four latent classes were identified and were named Low adversities, Moderate maltreatment with high household substance use, Severe maltreatment with moderate household dysfunction and Severe multi-type adversities. Relative to the Low adversities class, the three maltreatment/dysfunction classes had significantly elevated odds ratios (1.72-2.29) for adult incarceration, when controlling for sociodemographic characteristics and alcohol and drug use. The results point to the importance of examining childhood risk factors for incarceration and suggest that a certain sub-group of military personnel who are about to transition into the civilian life may need additional support to adjust and live successful lives.

Post-traumatic stress disorder (PTSD) symptoms are associated with addictive behaviors including problematic smartphone use (PSU). Drawing from existing theoretical models and empirical work, we examined the relation between PTSD symptoms, social/process-oriented smartphone feature uses, and PSU. Specifically, we examined the correlations between social/process-oriented smartphone feature uses with both PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity) and PSU and the mediating role of social/process-oriented smartphone feature uses in the relation between PTSD symptom clusters and PSU. The current study used data from a sample of 347 community participants recruited through Amazon’s Mechanical Turk platform. Correlation results indicated that process-oriented smartphone feature uses correlated significantly (positively) with all the PTSD symptom clusters and PSU. Further, mediation results indicated that process-oriented smartphone feature use significantly mediated the relationship between each PTSD symptom cluster and PSU. Beyond highlighting the role of process-oriented smartphone feature uses (e.g., watching videos/TV/movies, reading books/magazines, games) in the relation between PTSD symptoms and PSU, our findings suggest that efforts to reduce PSU among individuals with PTSD symptoms should integrate strategies for reducing process-oriented uses of smartphones.

Trauma exposure is linked to heavy drinking and drug use among college students. Extant research reveals positive associations between negative affect lability and both trauma exposure and alcohol use. This study aimed to extend past research by using daily diary methods to test whether (a) individuals with (versus without) trauma exposure experience greater negative and positive affect lability, (b) negative and positive affect lability are associated with heavy drinking and drug use, and (c) negative and positive affect lability mediate the relations between trauma exposure and heavy drinking and drug use. Participants were 1,640 college students (M age = 19.2, 54% female, 80% European American) who provided daily diary data for 30 days via online surveys. Daily diaries assessed negative and positive affect and substance use (i.e., percent days of heavy drinking, percent days of drug use, total number of drugs used). Individuals with (versus without) a history of trauma exposure demonstrated higher levels of negative and positive affect lability. Negative, but not positive, affect lability was associated with percent days of heavy drinking, percent days of drug use, and total number of drugs used, and mediated the associations between trauma exposure and heavy drinking and drug use outcomes. Findings provide support for the underlying role of negative affect lability in the relations between trauma exposure and heavy drinking and drug use among college students, suggesting that treatments targeting negative affect lability may potentially serve to reduce heavy drinking and drug use among trauma-exposed college students.

The experience of traumatizing events and resulting posttraumatic stress disorder (PTSD) symptomology relates to a range of impulsive behaviors. While both PTSD and impulsivity are heterogeneous and multidimensional constructs, no research has used person-centered approaches to examine subgroups of individuals based on these response endorsements. Hence, our study examined PTSD-impulsivity typologies and their construct validity in two samples: university students (n = 412) and community participants recruited through Amazon’s MTurk (n = 346). Measures included the Stressful Life Events Screening Questionnaire (PTEs), PTSD Checklist for DSM-5 (PTSD severity), UPPS Impulsive Behavior Scale (negative urgency, lack of premeditation, lack of perseverance, sensation seeking). Dimensions of Anger Reaction Scale (anger), and the Patient Health Questionnaire-9 (depression). For both samples, results of latent profile analyses indicated a best-fitting 3-class solution: High, Moderate, and Low PTSD-Negative Urgency. Negative urgency was the most distinguishing impulsivity facet. Anger and depression severity significantly predicted membership in the more severe symptomatology classes. Thus, individuals can be meaningfully categorized into three subgroups based on PTSD and impulsivity item endorsements. We provide some preliminary evidence for a negative urgency subtype of PTSD characterized by greater depression and anger regulation difficulties; and underscore addressing emotional regulation skills for these subgroup members.

We examined the frequency of trauma types reported in a cohort of service members seeking treatment for posttraumatic stress disorder (PTSD) and compared symptom profiles between types. In this observational study, 999 service members (9.2% women; Mage = 32.91 years; 55.6% White) were evaluated using a standardized assessment procedure to determine eligibility for clinical trials. Participants were evaluated for DSM-IV-TR-defined PTSD using the PTSD Symptom Scale-Interview; all participants reported a Criterion A event. Independent evaluators rated descriptions of Criterion A events as belonging to trauma types at a high degree of reliability, κ = 0.80. Aggregated non-life-threat primary trauma types were more frequently endorsed than aggregated life-threat types, 95% CI [17.10%, 29.20%]. Participants who endorsed moral injury-self traumas had a higher level of reexperiencing (d = 0.39), guilt (hindsight bias, d = 1.06; wrongdoing, d = 0.93), and self-blame (d = 0.58) symptoms, relative to those who reported life threat-self. Participants who experienced traumatic loss had greater reexperiencing (d = 0.39), avoidance (d = 0.22), guilt (responsibility, d = 0.39), and greater peri- and posttraumatic sadness (d = 0.84 and d = 0.70, respectively) symptoms, relative to those who endorsed life threat-self. Relative to life threat-self, moral injury-others was associated with greater peri- (d = 0.36) and posttraumatic (d = 0.33) betrayal/humiliation symptoms, and endorsement of aftermath of violence was associated with greater peri- (d = 0.84) and posttraumatic sadness (d = 0.57) symptoms. War zone traumas were heterogeneous, and non-life-threat traumas were associated with distinct symptoms and problems.

The detrimental impact of early trauma, particularly childhood maltreatment, on mental health is well documented. Although it is understood that social support can act as a protective factor toward mental health for children who experience such adversity, few studies have addressed the experience of childhood maltreatment and the important function of social support in adulthood. The current study aimed to assess the mediating role of social support in the relationship between childhood experiences of maltreatment and mental health outcomes including anxiety, depression, posttraumatic stress disorder (PTSD), and problematic alcohol use in a sample of university students ( N = 640) from Northern Ireland. Results of binary logistic regression analyses indicated that those reporting experiences of childhood maltreatment were at increased odds of mental health outcomes of PTSD, anxiety, and depression, but not alcohol use. Those reporting greater social support were significantly less likely to report on these mental health outcomes. In addition, the indirect paths from childhood maltreatment through social support to PTSD, depression, and anxiety were all significant, suggesting that social support, particularly family support, is a significant mediator of these relationships. Such findings have important implications for the social care response to children experiencing maltreatment and future support for such children as they transition to adolescence and adulthood.

There has been exponential growth in research on emotion regulation and substance use in the past decade. The current meta-analysis evaluated variability in the magnitude of the relation between aspects of emotion regulation and substance use. A search of PsycINFO, Embase, PubMed, CINAHL Plus, and PILOTS in December 2020 resulted in 6,642 initial studies, of which 95 met inclusion criteria (association between emotion regulation and substance use was reported, participants were > 18 years old, article was in English). A total of 445 effects were obtained (N = 156,025 participants; weighted M(age) = 29.31; 59.5% female; 66.1% White; 76.6% non-clinical). Emotion regulation and substance use were significantly related (r = 0.19; p < .001; 95%CI [0.17, 0.20]). Emotion regulation abilities were generally more strongly related to substance use than emotion regulation strategies; this pattern was stronger for behavioral vs. cognitive abilities and extended to both negative and positive emotions. Relations were stronger for older and clinical samples; mixed effects were found for sex and no conclusive effects were found for race. Despite limitations of the existing literature (e.g., cross-sectional, self-reports), results indicated that the magnitude of the relation between emotion regulation and substance use varied considerably as a function of emotion regulation and substance use constructs and sample characteristics.

Symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder are the most frequently co-occurring problems following potentially traumatic events. It is unclear whether these comorbidities represent two correlated but distinct disorders or a common post-event response. We sought to inform this question by examining the distinctiveness of PTSD and depression symptoms at four cross-sectional time points, using data from a parent prospective longitudinal study of 858 Marines evaluated before deployment and approximately 1, 5, and 8 months after returning from the Afghanistan war. We conducted a series of cross-sectional confirmatory factor analyses of PTSD and depression symptoms at each time point, using the Posttraumatic Stress Disorder Checklist IV and the Beck Depression Inventory II. Analyses indicated that across all four assessments, self-reported symptoms on the measures were best explained by distinct but correlated subclusters of symptoms within each measure. This structure was supported by the data both before and after deployment, even with increases in average PTSD symptoms after deployment. These findings suggest that despite shared method variance and some symptom overlap, self-reports of PTSD and depression symptoms across a stressful combat deployment show distinct symptom subclusters rather than a general common trauma reaction in this sample of Marines.

A new symptom criterion of reckless and self-destructive behaviors (E2) was recently added to posttraumatic stress disorder's (PTSD) diagnostic criteria in DSM-5, which is unsurprising given the well-established relation between PTSD and risky behaviors. Researchers have questioned the significance and incremental validity of this symptom criterion within PTSD's symptomatology. Unprecedented to our knowledge, we aim to compare trauma-exposed groups differing on their endorsement status of the risky behavior symptom on several psychopathology constructs (PTSD, depression, distress tolerance, rumination, anger). The sample included 123 trauma-exposed participants seeking mental health treatment (M age=35.70; 68.30% female) who completed self-report questionnaires assessing PTSD symptoms, depression, rumination, distress tolerance, and anger. Results of independent samples t-tests indicated that participants who endorsed the E2 criterion at a clinically significant level reported significantly greater PTSD subscale severity; depression severity; rumination facets of repetitive thoughts, counterfactual thinking, and problem-focused thinking; and anger reactions; and significantly less absorption and regulation (distress tolerance facets) compared to participants who did not endorse the E2 criterion at a clinically significant level. Results indicate the utility of the E2 criterion in identifying trauma-exposed individual with greater posttraumatic distress, and emphasize the importance of targeting such behaviors in treatment.

The meaningful interpretation of longitudinal study findings requires temporal stability of the constructs assessed (i.e., measurement invariance). We sought to examine measurement invariance of the construct of posttraumatic stress disorder (PTSD) as based on the Diagnostic and Statistical Manual of Mental Disorders indexed by the PTSD Checklist (PCL) and the Clinician-Administered PTSD Scale (CAPS) in a sample of 834 Marines with significant combat experience. PTSD was assessed 1-month predeployment (T0), and again at 1-month (T1), 5-months (T2), and 8-months postdeployment (T3). We tested configural (pattern of item/parcel loadings), metric (item/parcel loadings on latent factors), and scalar (item/parcel-level severity) invariance and explored sources of measurement instability (partial invariance testing). The T0 best-fitting emotional numbing model factor structure informed the conceptualization of PTSD's latent factors and parcel formations. We found (1) scalar noninvariance for the construct of PTSD as measured by the PCL and the CAPS, and for PTSD symptom clusters as assessed by the CAPS; and (2) metric noninvariance for PTSD symptom clusters as measured by the PCL. Exploratory analyses revealed factor-loading and intercept differences from pre- to postdeployment for avoidance symptoms, numbing symptoms (mainly psychogenic amnesia and foreshortened future), and the item assessing startle, each of which reduced construct stability. Implications of these findings for longitudinal studies of PTSD are discussed.

Research has identified heterogeneous subgroups of individuals based on posttraumatic stress disorder (PTSD) and depression symptoms. Using data collected from military personnel in India (N = 146) and U.S. (N = 194), we examined (1) the best-fitting latent class solution; (2) multi-group invariance of the class solution; and (3) construct validity of optimal class solution. Results indicated that the optimal 4-class solution differed in severity and severity/type in the India and U.S. samples respectively. With similarity in the optimal number of classes across cultural samples, the meaning/nature of classes differed. In the India sample, anxiety severity predicted the Low Severity Class vs. all other classes, and the Moderately High Severity/High Severity Classes vs. the Moderately Low Severity Class; number of traumas predicted the High Severity Class vs. other classes; and resilience predicted the Moderately Low Severity Class vs. the Moderately High Severity Class. In the U.S. sample, alcohol use predicted the High Severity Class vs. all other classes, and the High Depression-Low PTSD Class vs. the Low Severity Class; rumination significantly predicted the High Severity and High Depression-Low PTSD Classes vs. each of the High PTSD-Low Depression and Low Severity Classes. Thus, meaning and nature of PTSD-depression subgroups may vary culturally; hence, culturally-sensitive interventions need to account for this heterogeneity.

Introduction: Military sexual trauma (MST) is a serious and pervasive problem among military men and women. Recent findings have linked MST with various negative outcomes including risky, self-destructive, and health-compromising behaviors. Objective: The current review summarizes the existing literature on the association between MST and risky behaviors among military men and women who have served in the U.S. Armed Forces. Method: We systematically searched five electronic databases (PubMed, EMBASE, PSYCINFO, PILOTS, and CINAHL Plus) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the initial 2,021 articles, 47 met the inclusion criteria. Reviewed studies revealed three patterns of findings: (1) largely studied and consistent (i.e., suicidal behaviors, disordered eating), (2) mixed and in need of future research (i.e., alcohol and drug use, smoking), and (3) underexamined (i.e., sexual behaviors, illegal/aggressive behaviors) or completely neglected (e.g., problematic technology use, gambling). Discussion: The current systematic review advances literature by providing strong support for an association between MST and a wide range of risky behaviors. Moreover, it highlights important areas for future research.

A growing body of literature supports an association between posttraumatic stress disorder (PTSD) and emotion-driven impulsivity. The aim of this chapter is to synthesize theoretical and empirical research on the relation between PTSD and emotion-driven impulsivity, highlighting key psychological and biological mechanisms that may explain their association. In addition, we describe important avenues for future research, which include the following: (a) examination of the relation between PTSD and emotion-driven impulsivity stemming from positive emotions, (b) identification of the specific biological mechanisms underlying emotion-driven impulsivity in PTSD, and (c) exploration of the directionality of the association between PTSD and emotion-driven impulsivity. Finally, we end by discussing the potential relevance of the association between PTSD and emotion-driven impulsivity to assessment and intervention.

Positive memory characteristics relate to posttraumatic stress disorder (PTSD) severity. We utilized a network approach to examine relations between PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive memory characteristics (count, accessibility, valence, vividness, coherence, time perspective, sensory details). We identified differential relations between PTSD clusters and positive memory characteristics, and central/bridging symptoms. Participants were an Amazon Mechanical Turk-recruited sample of 206 individuals (Mage = 35.36; 61.20% females). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD clusters and six nodes representing positive memory characteristics. Regarding cross-community relations, AAR (highest node strength) was negatively associated with positive memory count, valence, coherence, and accessibility; avoidance was positively and negatively associated with positive memory vividness and count respectively. The NACM-AAR and intrusion-avoidance edges were significantly stronger than most edges. From the PTSD community, AAR and avoidance had the highest bridge strength and bridge expected influence respectively; from the positive memory community, coherence and vividness had the highest bridge strength and bridge expected influence respectively. Results indicate the potential pivotal role of AAR, avoidance, coherence, and vividness in the PTSD-positive memory relation, which renders them assessment/treatment targets pending further investigation.

Objective Emotion dysregulation is a transdiagnostic construct with relevance to a wide range of mental health outcomes. A growing literature highlights the contribution of positive emotion dysregulation to mental health outcomes. However, there remains limited understanding of the interplay of negative and positive emotion dysregulation on mental health outcomes. To address this limitation, the current study examined whether the association of positive emotion dysregulation to the mental health outcomes of posttraumatic stress disorder (PTSD), depression, and alcohol and drug misuse was attenuated by negative emotion dysregulation. Method Participants were 373 trauma-exposed individuals recruited from Amazon's MTurk (Mage = 35.74 years; 57.1% female; 75.9% White). Results Both negative and positive emotion dysregulation were positively related to PTSD, depression, and alcohol and drug misuse. Moderation analyses showed that negative emotion dysregulation did not attenuate the relations between positive emotion dysregulation and PTSD, depression, and alcohol and drug misuse. Discussion These findings suggest that the relation of positive emotion dysregulation to mental health outcomes may not be dependent on negative emotion dysregulation, supporting the utility of both negative and positive emotion dysregulation in identifying and treating mental health outcomes in trauma-exposed individuals. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

BACKGROUND AND OBJECTIVES: Literature provides support for the role of emotion dysregulation in the development and course of posttraumatic stress disorder (PTSD) among women victims of intimate partner violence (IPV). However, a dearth of studies have examined the contribution of emotion dysregulation stemming from positive emotions to PTSD. Extending research, the current study examined (1) the bivariate association of difficulties regulating positive emotions to PTSD symptom severity, and (2) the incremental role of difficulties regulating positive emotions in PTSD symptom severity beyond difficulties regulating negative emotions. DESIGN: Participants were 210 women victims of IPV involved in the criminal justice system because of their partners’ arrest (M age = 36.14, 48.6% African American). METHODS: Participants completed empirically-supported self-report measures assessing difficulties regulating positive and negative emotions and PTSD symptom severity. RESULTS: Difficulties regulating positive and negative emotions (overall and across each of the specific dimensions) were significantly positively associated with PTSD symptom severity. Moreover, difficulties regulating positive emotions demonstrated an incremental relation to PTSD symptom severity beyond the variance accounted for by difficulties regulating negative emotions. CONCLUSIONS: Our findings suggest the potential utility of targeting difficulties regulating positive emotions in interventions for PTSD among women victims of IPV.

Criterion E2 ("reckless or self-destructive behavior") was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/self-destructive behavior, we examined the prevalence and associations of RUBs (e.g., substance misuse, risky sexual behaviors) with criterion E2 endorsement. Further, we examined associations between criterion E2 and psychiatric conditions (e.g., depressive disorders, anxiety disorders) in a population-based sample of trauma-exposed adults. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed lifetime DSM-5 psychiatric conditions and self-reported RUBs. Among trauma-exposed adults (n = 23,936), multiple logistic regressions examined criterion E2's associations with RUBs and psychiatric conditions. After adjusting for covariates, all RUBs were associated with E2 endorsement (AOR range: 1.58-3.97; most prevalent RUB among those who endorsed E2: greater substance use than intended [57.0 %]) except binge eating, and E2 endorsement was associated with increased odds of PTSD, bipolar disorder, substance use disorders, and schizotypal, borderline, and antisocial personality disorders (AOR range: 1.65-2.75), and decreased odds of major depressive disorder (AOR = 0.76). Results support the clinical significance of criterion E2 through identifying associated RUBs and distinct correlates. These results may inform screening and intervention strategies for at-risk populations.

BACKGROUND: Given that marijuana use is often associated with detrimental physical and mental health problems, research examining motives for its use is critical for effective remedial and preventive treatment. To date, the majority of research on marijuana use motives has used variable-centered analyses, which overlooks potentially meaningful heterogeneous response patterns and the associations of those patterns with other risk/protective factors. METHODS: To address this gap, in the current study, we conducted a person-centered analysis (latent profile analysis) to identify subgroups of participants based on endorsed marijuana use motives, and examined the construct validity of the optimal class solution (covariates included sociodemographic (e.g., age), psychiatric (e.g., depression), and marijuana-use indices (e.g., use-frequency, use-related problems). Participants were 898 college students (M(age) = 20.93, SD(age) = 3.10; 68.9% female) who completed an anonymous online survey examining substance use and psychological well-being, were 18 years or older, and endorsed lifetime marijuana use. Data were collected November 2016 through February 2018. RESULTS: Results identified four unique classes of coping, conformity, social, and enhancement marijuana use motives: (a) “Low Motives” (37.6%), (b) “High Conformity” (4.9%), (c) “Low Conformity” (45.8%), and (d) “High Motives” (11.7%). In terms of covariates, higher motive classes tended to report more frequent and problematic use. The two classes uniquely characterized by conformity motives only differed on past-month marijuana use frequency. CONCLUSIONS/IMPORTANCE: The current findings provide evidence that specific classes of motives were not only associated with marijuana use frequency and problems but other risk and protective factors, such as anxiety sensitivity and social support.

OBJECTIVES Emotion dysregulation is a transdiagnostic factor central to the etiology and treatment of various clinical difficulties. Yet, research in this area has focused almost exclusively on emotion dysregulation stemming from negative emotions. The current study confirmed the factor structure of the Difficulties in Emotion Regulation Scale-Positive (DERS-P) and further examined its reliability and validity. METHOD Participants in Study 1 were 229 college students (M age = 19.37 years; 66.8% female; 67.2% White). Participants in Study 2 were 353 trauma-exposed community individuals ( M age = 35.77 years; 57.8% female; 71.2% White). RESULTS Findings supported the three-factor structure of the DERS-P. Mean levels of the DERS-P scales demonstrated convergent and discriminant validity and differentiated individuals with (vs. without) probable posttraumatic stress disorder, depression, alcohol use, and drug use disorders. CONCLUSIONS Findings provide additional support for the factor structure, reliability, and validity of the DERS-P, thereby adding to its clinical utility.

Background and objectives Although trauma research and therapy primarily focus on traumatic memories, recent evidence indicates positive memory processes play a role in the etiology/maintenance of posttraumatic stress disorder (PTSD) symptom severity. We examined the effects of a novel positive memory processing technique on PTSD symptom severity, depression symptom severity, affect, posttrauma cognitions, and self-esteem. Methods Sixty-five trauma-exposed participants were randomly assigned to one of three conditions (narrating/processing vs. writing/processing two specific positive memories, or a time-matched control) and completed self-report measures pre- and post-task (T0). About one week later, participants repeated their assigned task condition and completed self-report measures pre- and post-task (T1). We conducted mixed ANOVAs to examine the impact of the technique on study variables over time. Results The narrating condition had significant decreases in PTSD symptom severity, posttrauma cognitions, and negative affect from T0 pre-task to T1 post-task; and significant increases in positive affect from T0 pre-to-post-task and from T1 pre-to-post-task. The writing condition had significant increases in positive affect from T0 pre-to-post-task, but a significant decrease from T0 post-task to T1 post-task; and significant decreases in negative affect from T0 pre-to-post-task with an increase from T0 post-task to T1 post-task. Limitations Use of self-report measures, non-clinical convenience sample with less gender/ethnic/racial diversity, small sample size, methodological differences in time frames for measures, and no examination of follow-up effects. Conclusions Narrating and processing specific positive memories had a beneficial impact on PTSD symptom severity, posttrauma maladaptive cognitions, and affect; such results provide an impetus to examine positive memory interventions in trauma clinical work.

Introduction Nurses may experience frequent nightmares due to stressful work environments. Some studies estimate that 35% of nurses experience nightmares related to experiences at work. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmare occurrence and severity, and whether posttraumatic stress disorder (PTSD) symptoms moderated those relationships. Methods 392 nurses (mean age = 39.54 years; SD = 11.15; 92% female; 78% White) were recruited for a larger study on sleep and vaccine response. For 14 days, upon awakening, nurses completed daily sleep diaries to assess previous-day stress severity (0 = not at all, 4 = extremely), as well as nightmare occurrence (0 = no nightmare, 1 = nightmare occurred) and nightmare severity (0 = not at all, 3 = very). PTSD symptoms were assessed at baseline using the PTSD Checklist of DSM-5 (PCL-5). Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms. Results Approximately 10.5% of nurses met criteria for PTSD based on PCL-5 scores. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress severity were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity that night (b = 0.09, p = 0.033). Nightmare occurrence (b = 0.15, p < 0.001) was associated with greater next-day stress severity. PTSD symptoms did not moderate daily stress and nightmare associations. Conclusion Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Our results indicated nightmares and stress may occur in a bidirectional fashion among nurses. Results were similar regardless of nurses’ PTSD status. Future studies should explore whether targeting nightmares and stress may improve nurses’ health and well-being. Given the essential role that nurses play in maintaining patient health and safety, it is critical to understand the causes and consequences of their sleep-related disturbances. Support (if any)

The Posttrauma Risky Behaviors Questionnaire (PRBQ) is a screening measure for posttrauma reckless and self-destructive behaviors (RSDBs). We examined (1) PRBQ’s predictive relations with clinical (vs. not) endorsements of distinct RSDBs, and (2) PRBQ’s optimal cutoff score yielding the most appropriate balance of sensitivity and specificity statistics. The sample included 354 adult trauma-exposed community participants (M(age)=35.76 years; 57.90% female). Logistic regression analyses indicated that the PRBQ significantly differentiated individuals endorsing (vs. not) clinical levels of alcohol/drug misuse, disordered eating, problematic gambling, and compulsive buying. Receiver operating characteristic (ROC) curve analyses indicated that the 14-item PRBQ total score had moderate accuracy in differentiating individuals endorsing clinical vs. non-clinical levels of drug misuse, disordered eating, problematic gambling, compulsive buying, and engagement in RSDBs (PTSD’s E2 Criterion); and low accuracy for alcohol misuse. ROC curve analyses indicated 3.5–6.5 as the optimal range of PRBQ cutoff scores. Thus, the PRBQ has good ability to discriminate participants endorsing (vs. not) clinical levels of alcohol/drug misuse, disordered eating, problematic gambling, and compulsive buying (lowest accuracy in identifying participants with clinical levels of alcohol misuse), and a minimum cutoff score between 3.5 and 6.5 may suggest using additional diagnostic assessments and clinical interventions.

OBJECTIVE Posttraumatic stress disorder (PTSD) has a well-established theoretical and empirical relation with impulsivity. Prior research has not used a multidimensional approach for measuring both PTSD and impulsivity constructs when assessing their relationship. METHOD The current study assessed the unique relationship of impulsivity facets on PTSD symptom clusters among a nonclinical sample of 412 trauma-exposed adults. RESULTS Linear regression analyses revealed that impulsivity facets best accounted for PTSD's arousal symptoms. The negative urgency facet of impulsivity was most predictive, because it was associated with all of PTSD's symptom clusters. Sensation seeking did not predict PTSD's intrusion symptoms, but did predict the other symptom clusters of PTSD. Lack of perseverance only predicted intrusion symptoms, while lack of premeditation only predicted PTSD's mood/cognition symptoms. CONCLUSIONS Results extend theoretical and empirical research on the impulsivity-PTSD relationship, suggesting that impulsivity facets may serve as both risk and protective factors for PTSD symptoms. (PsycINFO Database Record

The PTSD diagnosis and latent structure were substantially revised in the transition from DSM-IV to DSM-5. However, three alternative models (i.e., anhedonia model, externalizing behavior model, and hybrid model) of PTSD fit the DSM-5 symptom criteria better than the DSM-5 factor model. Thus, the psychometric performance of the DSM-5 and alternative models' PTSD factor structure needs to be critically evaluated. The current study examined whether gender or trauma directness (i.e., direct or indirect trauma exposure) moderates the PTSD latent structure when using the DSM-5 or alternative models. Model performance was evaluated with measurement invariance testing procedures on a large undergraduate sample (n=455). Gender and trauma directness moderated the DSM-5 PTSD and externalizing behavior model and did not moderate the anhedonia and hybrid models' latent structure. Clinical implications and directions for future research are discussed.

Past research underscores the key role of coping strategies in the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD) symptoms. The goal of the current study was to extend existing literature by examining whether race/ethnicity moderates the relations among coping strategies (social support, problem-solving, avoidance) and PTSD symptom clusters (intrusion, avoidance, numbing, arousal).Participants were 369 community women (134 African Americans, 131 Latinas, 104 Whites) who reported bidirectional aggression with a current male partner. Multigroup path analysis was utilized to test the moderating role of race/ethnicity in a model linking coping strategies to PTSD symptom clusters.The strength and direction of relations among coping strategies and PTSD symptom clusters varied as a function of race/ethnicity. Greater social support coping was related to more arousal symptoms for Latinas and Whites. Greater problem-solving coping was related to fewer arousal symptoms for Latinas. Greater avoidance coping was related to more symptoms across many of the PTSD clusters for African Americans, Latinas, and Whites, however, these relations were strongest for African Americans.Results provide support for the moderating role of race/ethnicity in the relations among coping strategies and PTSD symptom clusters, and highlight potential targets for culturally informed PTSD treatments.

More investigation is needed to understand how specific posttraumatic stress disorder (PTSD) symptom clusters relate to the internal experience of anger and overt negative behaviors in response to anger (negative expressivity). We investigated whether anger mediated relations between PTSD symptom clusters and negative expressivity. Multiple regression revealed lower PTSD intrusion symptoms associated with higher levels of negative expressivity. Anger mediated this relationship. Higher avoidance symptoms related to higher negative expressivity. Clinical implications, limitations, and strengths are discussed.

Posttraumatic Stress Disorder (PTSD) is frequently comorbid with alcohol use disorders (AUD; Calabrese et al., 2011; McFall, Mackay, & Donovan, 1992). Among several explanations for this comorbidity, the most empirically supported is the self-medication theory which postulates that substances are used to medicate PTSD-related distress (Keane & Wolfe, 1990; Khantzian, 1985; Stewart, 1996). The current study examines the effects of trauma-related distress on alcohol use (total drinking days, drinks per drinking day, heavy drinking days) in a sample of 127 trauma-exposed Veterans following deployment to Iraq or Afghanistan. The dysphoria symptoms of PTSD were used as an indicator of distress, and examined as a moderator in the relationship between intrusion symptoms of PTSD and alcohol use. The proposed moderation model was tested using cross-sectional data from the first month following return from deployment, and at 6 months and at 12 months post-deployment. Results showed that dysphoria symptoms significantly moderated relations between intrusions and total drinking days and heavy drinking days at one month post-deployment; however, a significant pattern was not demonstrated at 6 months and 12 months. Further, dysphoria did not moderate the relation between intrusion symptoms and drinks per drinking day at the three time points. Theoretical and clinical implications are subsequently discussed.

Introduction The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse presents a pervasive and clinically relevant concern among US military veterans. Objective The current investigation sought to examine the role of positive emotion dysfunction in the relation between PTSD symptomatology and alcohol misuse. To do so, we examined the separate and sequential roles of positive emotional intensity and positive emotional avoidance in the relation between PTSD symptoms and alcohol misuse among US military veterans. Method Cross-sectional data were collected from 468 US military veterans (M age = 37.74, 70.5% male, 69.0% White) who responded to an online survey. Results Findings suggest that positive emotional avoidance, separately, and positive emotional intensity and positive emotional avoidance, sequentially, mediated the relation between PTSD symptoms and alcohol misuse. Conclusions Findings advance theory on the role of positive emotions and related processes in the co-occurrence of PTSD and alcohol misuse, and highlight important avenues for future research and treatment focused on the PTSD-alcohol misuse co-occurrence.

There is a widespread notion of the ‘college sophomore problem’ in social science research that posits that college student samples are samples of convenience with little generalizability to the general population. To address this concern, we conducted a critical review of the literature on college student samples in trauma research. Specifically, we reviewed how college student samples differ from non-college samples in four key areas of trauma research: (1) exposure rates to potentially traumatic events (PTEs), (2) prevalence of posttraumatic stress disorder (PTSD) symptoms, (3) factor structure of PTSD symptoms, and (4) PTSD’s relation with common markers, correlates, and consequences. Lastly, we discussed the value and advantages of using college student samples in trauma research. Results of the critical review indicated similar trends of trauma-related findings (Points 1–4) between college student samples and both U.S. nationally collected and treatment-seeking samples; specifically, we identified a comparable lifetime PTE exposure rate, comparable rates of PTSD, a comparable factor structure of PTSD symptoms, and a comparable pattern of associations between PTSD symptoms and post-trauma markers/correlates/consequences. Although trauma-exposed college student samples are biased in some key areas, they may be no more biased than other commonly used trauma samples (e.g. epidemiological, treatment-seeking). Results of this critical review highlight the need to re-examine potentially unfounded biases on the part of the trauma research community, as well as the need to consider advantages of using college student samples in trauma research.

Posttraumatic stress disorder (PTSD) is associated with significantly greater risk for suicidal ideation (SI). In civilians, the negative alterations in cognitions and mood (NACM) and alterations in arousal and reactivity (AAR) clusters are most strongly associated with SI. This study sought to examine the association between PTSD symptom clusters and SI in a large sample of veterans. Veterans (n = 1,789) completed the PTSD Checklist for DSM-5 and the Patient Health Questionnaire (PHQ) during primary care visits. Wald chi-square tests of parameter constraints were computed to test hypothesized relations between PTSD factors and the PHQ-9 suicidal ideation item. Each of the PTSD symptom clusters were significantly associated with SI. The NACM cluster was more strongly associated with SI than AAR and marginally more strongly associated with SI than the avoidance symptom clusters. In a restricted sample of only veterans with PTSD, NACM remained more strongly associated with SI than avoidance. Each of the NACM symptoms were significantly associated with SI. Changes in cognitions and mood were most strongly associated with SI in this large sample of veterans. These findings suggest that directly targeting the NACM symptom cluster may be an important goal for suicide prevention efforts among veterans with PTSD.

Objective: Posttraumatic stress symptoms (PTSS) have been found to be associated with alcohol (mis)use among college students. Anxiety sensitivity has been theoretically and empirically linked to both PTSS and alcohol (mis)use. The goal of the present study was to extend research by examining the relations among PTSS, anxiety sensitivity, and alcohol misuse within a sample of trauma-exposed Black college students. Methods: Participants were 121 Black undergraduate college students who endorsed exposure to a traumatic event (M age = 22.98, 77.7% female). Results: Correlational findings provide support for significant positive relations between PTSS and both anxiety sensitivity and alcohol misuse. Further, analyses revealed a significant indirect effect of anxiety sensitivity on alcohol misuse through PTSS. Specifically, greater anxiety sensitivity was associated with higher levels of PTSS, which, in turn, were associated with higher levels of alcohol misuse. Conclusions: These findings suggest that the assessment of anxiety sensitivity may be useful in identifying trauma-exposed Black individuals who are likely to experience alcohol misuse and the clinical utility of addressing PTSS in this population reporting anxiety sensitivity to possibly prevent alcohol misuse and related negative consequences.

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use is clinically-relevant. Emotion dysregulation is one factor that has been shown to underlie this association. However, literature in this area has been limited in its exclusive focus on emotion dysregulation stemming from negative emotions. The goal of the current study was to extend prior research by exploring the role of difficulties regulating positive emotions in the associations between PTSD symptom severity and both alcohol use and problems from drug use. Participants were 463 trauma-exposed individuals recruited from Amazon's MTurk (M age = 35.66 years; 55.7% female; 76.6% White). PTSD symptom severity, difficulties regulating positive emotions, alcohol use, and problems from drug use demonstrated significant positive zero-order correlations. Further, difficulties regulating positive emotions were found to account for the associations between PTSD symptom severity and both alcohol use and problems from drug use. Our results suggest the potential utility of addressing difficulties regulating positive emotions in interventions aimed at reducing substance use and abuse among individuals with PTSD.

We conducted a systematic review of studies that have evaluated invariance of the construct of posttraumatic stress disorder (PTSD) to summarize their conclusions related to invariance/noninvariance and sources of noninvariance. In November 2017, we searched Pubmed, PSYCINFO, PILOTS Web of Science, CINAHL, Medline, and Psychological and Behavioral Science Collection for abstracts and articles with these inclusionary criteria: peer-reviewed, including DSM-IV or DSM-5 PTSD invariance as a main study aim, use of multigroup confirmatory factor analyses, and use of an independent PTSD instrument or module. In total, 45 articles out of 1,169 initially identified abstracts met inclusion criteria. Research assistants then followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to complete a secondary search and independently extract data. Results indicated that DSM-IV dysphoric arousal and DSM-5 hybrid model factors demonstrated the most stability; sources of instability were some intrusion (distress to trauma cues), dysphoria/numbing (traumatic amnesia, foreshortened future, emotional numbness, detachment), and arousal (hypervigilance) items. The PTSD Checklist and PTSD Reaction Index were most often used to assess PTSD in studies investigating its invariance; however, these measures demonstrated partial conceptual equivalence of PTSD across subgroups. Instead, clinician-administered measures demonstrated more conceptual equivalence across subgroups. Age, gender, cultural/linguistic factors, and sample diversity had the least moderating effect on PTSD's symptom structure. Our review demonstrates the need to examine invariance of the PTSD construct following recommended guidelines for each empirical and clinical trial study to draw meaningful multigroup comparative conclusions.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Invarianza de medida en el constructo del Trastorno de Estrés Postraumático: una revisión sistemática TEPT E INVARIANZA DE MEDIDA Se realizó una revisión sistemática de los estudios que han evaluado la invariancia del constructo del trastorno de estrés postraumático (TEPT) para resumir sus conclusiones relacionadas con invariancia/no-invarianza y fuentes de no-invarianza. En noviembre de 2017, buscamos resúmenes y artículos en Pubmed, PSYCINFO, PILOTS Web of Science, CINAHL, Medline, y Psychological and Behavioral Science Collection con los siguientes criterios de inclusión: haber sido revisado por expertos, inclusión como objetivo principal del estudio de la invariancia del TEPT DSM-IV o DSM-5, el uso de análisis factorial confirmatorio multigrupo y uso de un instrumento o módulo de TEPT independiente. En total, 45 artículos de los 1,169 resúmenes identificados inicialmente cumplieron con los criterios de inclusión. Los asistentes de investigación siguieron luego las pautas de Informe de Elementos Preferidos para Revisiones y Metanálisis Sistemáticos (PRISMA en sus siglas en inglés) para completar una búsqueda secundaria y extraer datos de forma independiente. Los resultados indicaron que la activación disfórica del DSM-IV y los factores del modelo híbrido del DSM-5 demostraron mayor estabilidad, las fuentes de inestabilidad fueron algunos ítems de intrusiones (la angustia a las señales de trauma), disforia / adormecimiento (amnesia traumática, futuro cortoplacista, entumecimiento emocional, desapego), y elementos de activación (hipervigilancia). La lista de verificación de TEPT y el índice de reacción de TEPT fueron los más utilizados para evaluar el TEPT en los estudios que investigan su invariancia; sin embargo, estas medidas demostraron la equivalencia conceptual parcial de trastorno de estrés postraumático entre subgrupos. En su lugar, las medidas administradas por un médico demostraron una mayor equivalencia conceptual entre los subgrupos. Edad, género, factores culturales / lingüísticos y la diversidad de la muestra tuvieron el menor efecto moderador en las estructura de los síntomas de TEPT. Nuestra revisión demuestra la necesidad de examinar la invariancia del constructo de TEPT de acuerdo con las pautas recomendadas para los estudios empíricos y ensayos clínicos para sacar conclusiones significativas de comparaciones multigrupo.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Invariance of the Construct of Posttraumatic Stress Disorder: A Systematic Review Traditional Chinese 標題: 創傷後壓力症的構念不變性:系統性回顧 撮要: 我們對檢視創傷後壓力症(PTSD)的構念不變性的研究進行系統性回顧, 以概括它們對不變性/非不變性以及非不變性來源相關的研究結論。我們於2017年11月在以下資料庫進行搜尋:Pubmed、PSYCINFO、PILOTS Web of Science、CINAHL、Medline、Psychological and Behavioral Science Collection, 以找出內容含有以下範疇的論文撮要和文章:已受同儕審查、研究主要目的包括檢視DSM-IV 或 DSM-5的PTSD不變性、使用了多組別驗證性因素分析、採用獨立的PTSD工具或單元。我們在初步找出的1,169份論文撮要中, 得出45篇文章符合內容準則。研究助理依照「系統性回顧及統合分析報告標準(PRISMA)」提供的指引, 完成第二重搜尋並獨立地抽取數據。結果反映, DSM-IV的不安激發與DSM-5的混合模型因素展現最強的穩定性;不穩定性的來源包括一些侵擾 (對創傷提示感到悲痛) 、不安/麻木 (創傷性失憶、未來縮短感、情感麻木、抽離) 、及激發的項目 (過度警覺) 。探查PTSD不變性的研究最常用PTSD檢查表和PTSD反應指數來評估PTSD。然而, 這些測量工具展現PTSD在不同的子組別間只有部分的概念同等性;由臨床治療師執行的測量法, 在子組別間則有較大的概念同等性。年齡、性別、文化/語言因素與樣本的多元性對於PTSD症狀結構的調節效應為最小。我們的回顧反映, 有需要依照指引去檢視所有實證和臨床試驗研究裡PTSD構念的不變性, 從而透過比較多個組別取得有用結論。 Simplified Chinese 标题: 创伤后压力症的构念不变性:系统性回顾 撮要: 我们对检视创伤后压力症(PTSD)的构念不变性的研究进行系统性回顾, 以概括它们对不变性/非不变性以及非不变性来源相关的研究结论。我们于2017年11月在以下数据库进行搜寻:Pubmed、PSYCINFO、PILOTS Web of Science、CINAHL、Medline、Psychological and Behavioral Science Collection, 以找出内容含有以下范畴的论文撮要和文章:已受同侪审查、研究主要目的包括检视DSM-IV 或 DSM-5的PTSD不变性、使用了多组别验证性因素分析、采用独立的PTSD工具或单元。我们在初步找出的1,169份论文撮要中, 得出45篇文章符合内容准则。研究助理依照「系统性回顾及统合分析报告标准(PRISMA)」提供的指引, 完成第二重搜寻并独立地抽取数据。结果反映, DSM-IV的不安激发与DSM-5的混合模型因素展现最强的稳定性;不稳定性的来源包括一些侵扰 (对创伤提示感到悲痛) 、不安/麻木 (创伤性失忆、未来缩短感、情感麻木、抽离) 、及激发的项目 (过度警觉) 。探查PTSD不变性的研究最常用PTSD检查表和PTSD反应指数来评估PTSD。然而, 这些测量工具展现PTSD在不同的子组别间只有部分的概念同等性;由临床治疗师执行的测量法, 在子组别间则有较大的概念同等性。年龄、性别、文化/语言因素与样本的多元性对于PTSD症状结构的调节效应为最小。我们的回顾反映, 有需要依照指引去检视所有实证和临床试验研究里PTSD构念的不变性, 从而透过比较多个组别取得有用结论。.

Within the United States, risky sexual behavior (RSB) is the primary mode of HIV transmission. The role of emotion dysregulation in RSB has received growing attention over the past decade. However, this literature has been limited in its focus on emotion dysregulation stemming from negative (but not positive) emotions. The goal of the current study was to extend research by examining the relative and unique contributions of dimensions of difficulties regulating positive emotions (i.e., nonacceptance of positive emotions [Accept], difficulties controlling impulsive behaviors when experiencing positive emotions [Impulse], and difficulties engaging in goal-directed behaviors when experiencing positive emotions [Goals]) to RSB. Participants were 386 trauma-exposed individuals recruited from Amazon’s MTurk (M age = 35.85 years; 57.5% female; 76.4% White). At the bivariate level, dimensions of difficulties regulating positive emotions were significantly positively associated with sexual risk taking with uncommitted partners, impulsive sex behaviors, and intent to engage in risky sexual behaviors (with the exception of Goals to sexual risk taking with uncommitted partners), and significantly negatively associated with risky sex acts. Regarding the unique contributions of difficulties regulating positive emotions to RSB, (a) Accept was significantly positively associated with impulsive sexual behaviors and intent to engage in risky sexual behaviors; (b) Impulse was significantly positively associated with risky anal sex acts; and (c) Goals was significantly negatively associated with risky anal sex acts. Findings suggest the potential utility of targeting difficulties regulating positive emotions in treatments aimed at reducing RSB.

Posttraumatic stress disorder (PTSD) is comorbid with diverse reckless and self-destructive behaviors (RSDBs). We examined the nature and construct validity (covariates of age, gender, depression severity, number of trauma types, functional impairment) of the optimal class solution categorizing participants based on PTSD symptom and RSDB endorsement. The sample included 417 trauma-exposed individuals recruited through Amazon's MTurk platform who completed the Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, the Posttrauma Risky Behaviors Questionnaire, and Patient Health Questionnaire-9. Latent profile analyses indicated an optimal three-class solution: the Low PTSD-RSDBs, High PTSD-Low RSDBs, and High PTSD-RSDBs classes. Multinomial logistic regression indicated that impairment and depression predicted the High PTSD-Low RSDBs vs. the Low PTSD-RSDBs classes. Impairment, age, being female, and depression predicted the High vs. Low PTSD-RSDBs classes. Number of trauma types, age, being female, and depression predicted the High PTSD-RSDBs vs. High PTSD-Low RSDBs classes. Results support the presence of a reckless behaviors subtype of PTSD (characterized by greater depression, greater impariment, greater number of trauma types, being male, and being younger), conducting comprehensive assessments of RSDBs for individuals reporting PTSD symptoms and of PTSD symptoms for individuals reporting RSDBs, and the need to tailor interventions to treat PTSD and RSDBs concurrently.

Case-mix is common in clinical trials and treatment effect can vary across different subgroups. Conventionally, a subgroup analysis is performed by dividing the overall study population by one or two grouping variables. It is usually impossible to explore complex high-order intersections among confounding variables. Latent class analysis (LCA) provides a framework to identify latent classes by observed manifest variables. Distal clinical outcomes and treatment effect can be different across these classes. This paper provides a step-by-step tutorial on how to perform LCA with R. A simulated dataset is generated to illustrate the process. In the example, the classify-analyze approach is employed to explore the differential treatment effects on distal outcomes across latent classes.

Introduction Alcohol and drugs are widely used among college students. Emotion dysregulation has been identified as a key mechanism in the etiology, maintenance, and treatment of alcohol and drug misuse. Yet, research in this area has been limited by its narrow focus on dysregulation stemming from negative emotions. The goal of the current study was to extend past research by examining the relation of difficulties regulating positive emotions to alcohol and drug misuse. Methods Participants were 311 college students (Mage = 19.24; 66.1% female; 66.0% White) who completed measures assessing difficulties regulating positive emotions and alcohol and drug misuse. Results Structural equational modeling was used to model the relation between difficulties regulating positive emotions and alcohol and drug misuse. In a hypothesized structural model, higher levels of difficulties regulating positive emotions were found to relate to greater alcohol and drug misuse. Moreover, an alternative model provided support for an association of greater drug (but not alcohol) misuse to higher levels of difficulties regulating positive emotions. Conclusions If replicated, findings may suggest the utility of targeting difficulties regulating positive emotions in treatments aimed at reducing alcohol and drug misuse among college students.

OBJECTIVE: Cognitive models of posttraumatic stress disorder (PTSD) propose that rumination about a trauma may increase particular symptom clusters. One type of rumination, termed counterfactual thinking (CFT), refers to thinking of alternative outcomes for an event. CFT centered on a trauma is thought to increase intrusions, negative alterations in mood and cognitions (NAMC), and marked alterations in arousal and reactivity (AAR). The theorized relations between CFT and specific symptom clusters have not been thoroughly investigated. Also, past work has not evaluated whether the relation is confounded by depressive symptoms, age, gender, or number of traumatic events experienced. METHOD: The current study examined the unique associations between CFT and PTSD symptom clusters according to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) in 51 trauma-exposed treatment-seeking individuals. RESULTS: As predicted, CFT was associated with all PTSD symptom clusters. After controlling for common predictors of PTSD symptom severity (i.e., age, depressive symptoms, and number of traumatic life events endorsed), we found CFT to be significantly associated with the intrusion and avoidance symptom clusters but not the AAR or NAMC symptom clusters. CONCLUSIONS: Results from the present study provide further support for the role of rumination in specific PTSD symptom clusters above and beyond symptoms of depression, age, and number of traumatic life events endorsed. Future work may consider investigating interventions to reduce rumination in PTSD. (PsycINFO Database Record (c) 2016 APA, all rights reserved) Language: en

The objective of this study was to evaluate the relationship between factors of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) using confirmatory factor analysis (CFA) in order to further our understanding of the substantial comorbidity between these two disorders. CFA was used to examine which factors of PTSD’s dysphoria model were most related to AUD in a military sample. Ohio National Guard soldiers with a history of overseas deployment participated in the survey (n = 1215). Participants completed the PTSD Checklist and a 12-item survey from the National Survey on Drug Use used to diagnosis AUD. The results of the CFA indicated that a combined model of PTSD’s four factors and a single AUD factor fit the data very well. Correlations between PTSD’s factors and a latent AUD factor ranged from correlation coefficients of 0.258–0.285, with PTSD’s dysphoria factor demonstrating the strongest correlation. However, Wald tests of parameter constraints revealed that AUD was not more correlated with PTSD’s dysphoria than other PTSD factors. All four factors of PTSD’s dysphoria model demonstrate comparable correlations with AUD. The role of dysphoria to the construct of PTSD is discussed.

Posttraumatic stress disorder (PTSD) is comorbid with major depressive disorder (MDD; Kessler et al., 1995) and generalized anxiety disorder (GAD; Brown et al., 2001). We aimed to (1) assess discrete patterns of post-trauma PTSD-depression-GAD symptoms using latent profile analyses (LPAs), and (2) assess covariates (gender, income, education, age) in defining the best fitting class solution. The PTSD Checklist (assessing PTSD symptoms), GAD-7 scale (assessing GAD symptoms), and Patient Health Questionnaire-9 (assessing depression) were administered to 1266 trauma-exposed Ohio National Guard soldiers. Results indicated three discrete subgroups based on symptom patterns with mild (class 1), moderate (class 2) and severe (class 3) levels of symptomatology. Classes differed in symptom severity rather than symptom type. Income and education significantly predicted class 1 versus class 3 membership, and class 2 versus class 3. In conclusion, there is heterogeneity regarding severity of PTSD-depression-GAD symptomatology among trauma-exposed soldiers, with income and education predictive of class membership.

Background: Distress tolerance (DT) and rumination both influence the development and maintenance of posttraumatic stress disorder (PTSD). However, few studies have investigated these constructs simultaneously. We investigated whether the regulation dimension of DT was associated with PTSD symptom clusters (intrusions, avoidance, negative alternations in cognitions and mood, alterations in arousal and reactivity), and whether counterfactual rumination (CFT) mediated these relationships. Methods: This cross-sectional study sampled trauma-exposed adults (N = 119) seeking mental health services at a community mental health center. Participants completed self-report measures of DT, rumination, and PTSD. Mediation analyses were conducted using the SPSS PROCESS Macro. Results: Lower scores on the DT regulation dimension were associated with higher PTSD symptom severity for all four symptom clusters, controlling for depression and number of traumas. CFT significantly mediated this relationship between DT's regulation and PTSD's intrusions and avoidance symptoms. Limitations: Limitations included use of self-report data and the cross-sectional nature of this data. Conclusions: Clinically, this study highlights that difficulties with regulating negative emotions can result in the use of maladaptive cognitive strategies, such as CFT. This, in turn, may exacerbate PTSD symptom severity, particularly intrusions and avoidance. This study highlights the importance of understanding specific dimensions of DT, rumination, and PTSD symptom clusters to develop precise and efficient psychological interventions. Keywords: PTSD, Emotion Regulation, Distress Tolerance, Rumination, Trauma

Context Polytraumatization classes based on trauma endorsement patterns relate to distinct clinical outcomes. Person-centered approaches robustly evaluate the nature, and construct validity of polytraumatization classes. Objective Our review examined evidence for the nature and construct validity of lifespan polytraumatization typologies. Data sources In September 2016, we searched Pubmed, PSYCINFO, PSYC ARTICLES, Academic Search Complete, PILPTS, Web of Science, CINAHL, Medline, PsycEXTRA, and PBSC. Search terms included "latent profile," "latent class," "latent analysis," "person-centered," "polytrauma," "polyvictimization," "traumatization," "lifetime," "cooccurring," "complex," "typology," "multidimensional," "sequential," "multiple," "subtype," "(re)victimization," "cumulative," "maltreatment," "abuse," and "stressor." Inclusionary criteria included: peer-reviewed; latent class/latent profile analyses (LCA/LPA) of lifespan polytrauma classes; adult samples of size greater than 200; only trauma types as LCA/LPA indicators; mental health correlates of typologies; and individual-level trauma assessment. Of 1,397 articles, nine met inclusion criteria. Data extraction Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, research assistants completed a secondary reference search, and independently extracted data with standardized coding forms. Results Three-class (n = 5) or four-class (n = 4) solutions were found. Seven studies found a class characterized by higher trauma endorsement (high-trauma). All studies found a class characterized by lower trauma endorsement (low-trauma), and predominance of specific traumas (specific-trauma; e.g., childhood maltreatment). High-trauma versus low-trauma classes and specific-trauma versus low-trauma classes differed on mental health correlates. Conclusion Evidence supports the prevalence of a high-trauma class experiencing poorer mental health, and the detrimental impact of aggregated interpersonal and other traumas. We highlight the clinical importance of addressing polytraumatization classes, and comprehensively assessing the impact of all traumas.

Posttraumatic stress disorder (PTSD) criteria in DSM-5 included a dissociative diagnostic subtype characterized by a depersonalization item and a derealization item. Researchers have queried whether this was too restrictive, as alternative dissociative symptomatology may also be characteristic of the subtype. The current study utilized data from 318 Northern Irish students, of which 165 were trauma exposed. Participants were assessed for PTSD symptomatology based on DSM-5 criteria via a modified version of the PTSD Symptom Scale-Self-Report (PSS-5) and dissociative experiences via the Dissociative Experiences Scale (DES). Confirmatory factor analysis of PTSD and DES models revealed an optimal four-factor DSM-5 PTSD model including reexperiencing, avoidance, negative alterations in mood and cognitions, and alterations in hyperarousal and reactivity factors, and an optimal three-factor DES model including absorption, amnesia, and depersonalization/derealization factors. When comparing the correlations between depersonalization/derealization and the four PTSD factors, significant Wald tests of parameter constraints revealed that depersonalization/derealization is more related to alterations in arousal and reactivity (r = .432) compared to avoidance (r = .289), χ 2 (1, N = 165) = 8.352, p = .004. We discuss whether the mechanism for comorbid PTSD and dissociation may be related to PTSD’s arousal factor.

Introduction The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement. Method The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (Mage = 35.62, 55.4% women, 77.0% White). Results Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model. Conclusions Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.