Top

Journal of Psychopathology and Behavioral Assessment

Gepubliceerd in:

08-03-2019

Anxiety Sensitivity Moderates the Effect of Posttraumatic Stress Disorder Symptoms on Emotion Dysregulation among Trauma-Exposed Firefighters

Auteurs: Katherine C. Paltell, Hanaan Bing-Canar, Rachel M. Ranney, Jana K. Tran, Erin C. Berenz, Anka A. Vujanovic

Gepubliceerd in: Journal of Psychopathology and Behavioral Assessment | Uitgave 3/2019

Abstract

Posttraumatic stress disorder (PTSD) symptoms are associated with significant emotion dysregulation, which in turn marks risk for greater symptom-related difficulties and psychiatric comorbidity. Individuals with PTSD symptoms who are high in anxiety sensitivity (AS; fear of anxiety and related sensations) may have particular difficulty managing negative affect, as they tend to perceive their trauma-related symptoms to be more threatening. The present study investigated the main and interactive effects of PTSD symptoms (PTSD Checklist for DSM-5) and AS (Anxiety Sensitivity Index-3) on emotion dysregulation (Difficulties in Emotion Regulation Scale-16) in a sample of 836 trauma-exposed firefighters (94.6% men; M_age = 38.5 years, SD = 8.5). Results of hierarchical linear regression models indicated that the main effects of PTSD symptom severity (β = .353, p < .001) and AS (β = .273, p < .001) were significantly positively associated with emotion dysregulation, accounting for 28.0% of variance. The interaction term accounted for an additional 2.0% of variance (β = .157, p < .001). Post hoc probing of simple slopes revealed that the strength of the association between PTSD symptom severity and emotion regulation was more than twice as strong for individuals high, compared to low, in AS. Exploratory analyses regarding subscales of the Difficulties in Emotion Regulation Scale-16 (i.e., Clarity, Goals, Impulse, Strategies, and Non-Acceptance) were also conducted. PTSD symptoms were associated with greater emotion dysregulation for all DERS-16 subscales; AS was associated with greater emotion dysregulation for all subscales with the exception of DERS-16 Impulse. AS moderated the association between PTSD symptoms and DERS-16 Strategies and DERS-16 Non-acceptance. Specifically, greater PTSD symptoms were associated with less access to emotion regulation strategies and greater non-acceptance of emotions for those high, compared to low, in AS. These findings provide novel information regarding the ways in which PTSD symptoms, AS, and emotion dysregulation are interrelated in trauma-exposed, active-duty firefighters.

vorige artikel Cultural Differences in Environmental Reward Across Individuals in China, Taiwan, and the United States

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237.PubMedCrossRef

Allan, N. P., Short, N. A., Albanese, B. J., Keough, M. E., & Schmidt, N. B. (2015). Direct and mediating effects of an anxiety sensitivity intervention on posttraumatic stress disorder symptoms in trauma-exposed individuals. Cognitive Behavior Therapy, 44(6), 512–524.CrossRef

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.PubMedCentralPubMedCrossRef

Bartlett, B. A., Jardin, C., Martin, C., Tran, J. K., Buser, S. J., Anestis, M., & Vujanovic, A. A. (2018a). Posttraumatic stress and suicidality in firefighters: The moderating role of distress tolerance. Cognitive Therapy and Research, 42, 483–496.CrossRef

Bartlett, B. A., Smith, L. J., Tran, J. K., & Vujanovic, A. A. (2018b). Understanding mental health among military veterans in the fire service. Psychiatry Research, 267, 394–399.PubMedCrossRef

Berenz, E. C., Kevorkian, S., Chowshury, N., Dick, D. M., Kendler, K. S., & Amstadter, A. B. (2016). Posttraumatic stress disorder symptoms, anxiety sensitivity, and alcohol-use motives in college students with a history of interpersonal trauma. Psychology of Addictive Behaviors, 30(7), 755–763.PubMedCentralPubMedCrossRef

Berking, M., Wirtz, C. M., Svaldi, J., & Hofmann, S. G. (2014). Emotion regulation predicts symptoms of depression over five years. Behaviour Research and Therapy, 57, 13–20.PubMedCrossRef

Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L.-G., Bjärehed, J., DiLillo, D., Messman-Moore, T., & Gumpert, C. H. (2016). Development and validation of a brief version of the Difficulties in Emotion Regulation Scale: The DERS-16. Journal of Psychopathology and Behavioral Assessment, 38(2), 284–296.PubMedCrossRef

Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498.PubMedCrossRef

Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379–1391.PubMedCrossRef

Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 542–559). New York: Guilford Press.

Capron, D. W., Cougle, J. R., Ribeiro, J. D., Joiner, T. E., & Schmidt, N. B. (2012). An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation. Journal of Psychiatric Research, 46(2), 174–180.PubMedCrossRef

Chandley, R. B., Luebbe, A. M., Messman-Moore, T. L., & Ward, R. M. (2014). Anxiety sensitivity, coping motives, emotion dysregulation, and alcohol-related outcomes in college women: A moderated-mediation model. Journal of Studies on Alcohol and Drugs, 75(1), 83–92.PubMedCrossRef

Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.

Corneil, W., Beaton, R., Murphy, S., Johnson, C., & Pike, K. (1999). Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries. Journal of Occupational Health Psychology, 4(2), 131–141.PubMedCrossRef

Ehring, T., & Quack, D. (2010). Emotion regulation difficulties in trauma survivors: The role of trauma type and PTSD symptom severity. Behavior Therapy, 41, 587–598.PubMedCrossRef

Farris, S. G., Paulus, D. J., Gonzalez, A., Mahaffey, B. L., Bromet, E. J., Luft, B. J., Kotov, R., & Zvolensky, M. J. (2015). Anxiety sensitivity mediates the association between post-traumatic stress symptom severity and interoceptive threat-related smoking abstinence expectancies among world trade center disaster-exposed smokers. Addictive Behaviors, 51, 204–210.PubMedCrossRef

Galatzer-Levy, I. R., Nickerson, A., Litz, B. T., & Marmar, C. R. (2013). Patterns of lifetime PTSD comorbidity: A latent class analysis. Depression and Anxiety, 30(5), 489–496.PubMedCrossRef

Gallagher, M. W. (2017). Transdiagnostic mechanisms of change and cognitive-behavioral treatments for PTSD. Current Opinion in Psychology, 14, 90–95.PubMedCrossRef

Goldstein, R. B., Smith, S. M., Chou, S. P., Saha, T. D., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Huang, B., & Grant, B. F. (2016). The epidemiology of DSM-5 posttraumatic stress disorder in the United States: Results from the National Epidemiologic Survey on alcohol and related conditions-III. Social Psychiatry and Psychiatric Epidemiology, 51(8), 1137–1148.PubMedCentralPubMedCrossRef

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), 41–55.CrossRef

Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psycho-metric properties of the Life Events Checklist. Assessment, 11(4), 330–341.PubMedCrossRef

Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a dialectical behavior therapy prolonged exposure protocol. Behaviour Research and Therapy, 50(6), 381–386.PubMedCentralPubMedCrossRef

Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55(1), 7–17.PubMedCentralPubMedCrossRef

Haynes, H.J.G., Stein, G.P. (2016). U.S. fire department profile. The national fire protection association.

Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. Journal of Pediatric Psychology, Special Issue on Methodology and Design, 27(1), 87–96.CrossRef

Keough, M. E., & Schmidt, N. B. (2012). Refinement of a brief anxiety sensitivity reduction intervention. Journal of Consulting and Clinical Psychology, 80(5), 766–772.PubMedCentralPubMedCrossRef

Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26(5), 537–547.PubMedCentralPubMedCrossRef

Kubany, E. S., Haynes, S. N., Leisen, M. B., Owens, J. A., Kaplan, A. S., Watson, S. B., & Burns, K. (2000). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment, 12(2), 210–224.PubMedCrossRef

Leen-Feldner, E. W., Feldner, M. T., Reardon, L. E., Babson, K. A., & Dixon, L. (2008). Anxiety sensitivity and posttraumatic stress among traumatic event-exposed youth. Behavior Research and Therapy, 46(4), 548–456.CrossRef

Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064.PubMedCrossRef

Marshall, G. N., Miles, J. N. V., & Stewart, S. H. (2010). Anxiety sensitivity and PTSD symptom severity are reciprocally related: Evidence from a longitudinal study of physical trauma survivors. Journal of Abnormal Psychology, 119(1), 143–150.PubMedCentralPubMedCrossRef

Mclean, C. P., & Anderson, E. R. (2009). Brave men and timid women? A review of the gender differences in fear and anxiety. Clinical Psychology Review, 29(6), 496–505.PubMedCrossRef

McNally, R. J., & Eke, M. (1996). Anxiety sensitivity, suffocation fear, and breath-holding duration as predictors of response to carbon dioxide challenge. Journal of Abnormal Psychology, 105(1), 146–149.PubMedCrossRef

Meyer, E. C., Zimering, R., Daly, E., Knight, J., Kamholz, B. W., & Gulliver, S. B. (2012). Predictors of posttraumatic stress disorder and other psychological symptoms in trauma-exposed firefighters. Psychological Services, 9(1), 1–15.PubMedCrossRef

Miles, S. R., Smith, T. L., Maieritsch, K. P., & Ahearn, E. P. (2015). Fear of losing emotional control is associated with cognitive processing therapy outcomes in US veterans of Afghanistan and Iraq. Journal of Traumatic Stress, 28, 475–479.PubMedCrossRef

Olthuis, J. V., Watt, M. C., Mackinnon, S. P., & Stewart, S. H. (2014). Telephone-delivered cognitive behavioral therapy for high anxiety sensitivity: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 82(6), 1005–1022.PubMedCrossRef

Osman, A., Gutierrez, P. M., Smith, K., Fang, Q., Lozano, G., & Devine, A. (2010). The Anxiety Sensitivity Index-3: Analyses of dimensions, reliability estimates, and correlates in nonclinical samples. Journal of Personality Assessment, 92, 45–52.PubMedCrossRef

Ouimet, A. J., Kane, L., & Tutino, J. S. (2016). Fear of anxiety or fear of emotions? Anxiety sensitivity is indirectly related to anxiety and depressive symptoms via emotion regulation. Cogent Psychology, 3(1), 1249132.CrossRef

Paulus, D. J., Gallagher, M. W., Bartlett, B. A., Tran, J., & Vujanovic, A. A. (2018). The unique and interactive effects of anxiety sensitivity and emotion dysregulation in relation to posttraumatic stress, depressive, and anxiety symptoms among trauma-exposed firefighters. Comprehensive Psychiatry, 84, 54–61.PubMedCrossRef

Pickover, A., Yurasek, A., Lejuez, C., & Murphy, J. (2014). Emotion regulation predicts drug use among college binge drinkers. Drug and Alcohol Dependence, 140, e176.CrossRef

*Rajappa, K., *Gallagher, M., & Miranda, R. (2012). Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cognitive Therapy and Research, 36(6), 833–839.

Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In S. Reiss & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107–121). NY: Academic Press.

Schmidt, N. B., & Trakowski, J. (2004). Interoceptive assessment and exposure in panic disorder: A descriptive study. Cognitive and Behavioral Practice, 11, 81–92.CrossRef

Sharma-Patel, K., & Brown, E. J. (2016). Emotion regulation and self blame as mediators and moderators of trauma-specific treatment. Psychology of Violence, 6(3), 400–409.CrossRef

Smith, L. J., Bartlett, B. A., Gallagher, M. W., Tran, J. K., Alfano, C. A., & Vujanovic, A. A.* (in press-a). Sleep disturbance among firefighters: Understanding associations with alcohol use and distress tolerance. Cognitive Therapy and Research.

Smith, L. J., Gallagher, M. W., Tran, J. K., & Vujanovic, A. A.* (in press-b). Posttraumatic stress, alcohol use, and alcohol use motives in firefighters: The role of sleep disturbance. Comprehensive Psychiatry.

Stanley, I. H., Boffa, J. W., Smith, L. J., Tran, J. K., Schmidt, N. B., Joiner, T. E., & Vujanovic, A. A. (2018). Occupational stress and suicidality among firefighters: Examining the buffering role of distress tolerance. Psychiatry Research, 266, 90–96.PubMedCentralPubMedCrossRef

Taylor, S., Koch, W. J., & McNally, R. (1992). How does anxiety sensitivity vary across the anxiety disorders? Journal of Anxiety Disorders, 6(3), 249–259.CrossRef

Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., Abramowitz, J. S., Holaway, R. M., Sandin, B., Stewart, S. H., Coles, M., Eng, W., Daly, E. S., Arrindell, W. A., Bouvard, M., & Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176–188.PubMedCrossRef

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.PubMedCrossRef

Tull, M. T., Bardeen, J. R., Dilillo, D., Messman-Moore, T., & Gratz, K. L. (2015). A prospective investigation of emotion dysregulation as a moderator of the relation between posttraumatic stress symptoms and substance use severity. Journal of Anxiety Disorders, 29, 52–60.PubMedCrossRef

Tull, M. T., Berghoff, C. R., Wheeless, L. E., Cohen, R. T., & Gratz, K. L. (2018). PTSD symptom severity and emotion regulation strategy use during trauma cue exposure among patients with substance use disorders: Associations with negative affect craving, and cortisol reactivity. Behavior Therapy, 49, 57–70.PubMedCrossRef

Van der Kolk, B. A., Pelcovitz, D., Roth, S., Mandel, F. S., McFarlane, A., & Herman, J. L. (1996). Dissociation, somatization, and affect dysregulation: The complexity of adaptation of trauma. American Journal of Psychiatry, 153(7), 83–93.PubMedCrossRef

VanderVeen, J. W., Gulliver, S. B., Morissette, S. B., Kruse, M. I., Kamholz, B. W., Zimering, R. T., Knight, J., & Keane, T. M. (2012). Differences in drinking patterns, occupational stress, and exposure to potentially traumatic events among firefighters: Predictors of smoking relapse. The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 21(6), 550–554.PubMedCentral

Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at www.ptsd.va.gov.

Weiss, N. H., Tull, M. T., Anestis, M. D., & Gratz, K. L. (2013). The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients. Drug and Alcohol Dependence, 128(2), 45–51.PubMedCrossRef

Weiss, N. H., Gratz, K. L., & Lavender, J. M. (2015). Factor structure and initial validation of a multidimensional measure of difficulties in the regulation of positive emotions: The DERS-positive. Behavior Modification, 39(3), 431–453.PubMedCentralPubMedCrossRef

Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B., Foa, E. B., Young-McCaughan, S., Yarvis, J. S., Hembree, E. A., Mintz, J., Peterson, A. L., & Litz, B. T. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28(11), 1392–1403.PubMedCrossRef

Zvolensky, M. J., Marshall, E. C., Johnson, K., Hogan, J., Bernstein, A., & Bonn-Miller, M. O. (2009). Relations between anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations to coping and conformity marijuana use motives among young adult marijuana users. Experimental and Clinical Psychopharmacology, 17(1), 31–42.PubMedCentralPubMedCrossRef

Titel: Anxiety Sensitivity Moderates the Effect of Posttraumatic Stress Disorder Symptoms on Emotion Dysregulation among Trauma-Exposed Firefighters
Auteurs: Katherine C. Paltell
Hanaan Bing-Canar
Rachel M. Ranney
Jana K. Tran
Erin C. Berenz
Anka A. Vujanovic
Publicatiedatum: 08-03-2019
Uitgeverij: Springer US
Gepubliceerd in: Journal of Psychopathology and Behavioral Assessment / Uitgave 3/2019
Print ISSN: 0882-2689
Elektronisch ISSN: 1573-3505
DOI: https://doi.org/10.1007/s10862-019-09731-4

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 3/2019

One-Month Stability of Cyberball Post-Exclusion Ostracism Distress in Adolescents

The Multidimensional Emotion Questionnaire (MEQ): Rationale and Initial Psychometric Properties

The Development and Validation of the Thwarted Belongingness Scale (TBS) for Interpersonal Suicide Risk

Emotion Vulnerability in the Context of Positively Valenced Stimuli: Associations with Borderline Personality Disorder Symptom Severity

A Psychometric Evaluation of the Distress Intolerance Index for Youth

Friendship Quality Moderates the Relation between Maternal Anxiety and Trajectories of Adolescent Internalizing Symptoms