Transcript Franz, M., Hein, C., Jaffe, A., Messman

Emotion Dysregulation as a
Prospective Predictor of PTSD
Following Sexual Assault
Molly Franz, M.A., Christina Hein, M.A., Anna Jaffe, M.A.,
Terri Messman-Moore, Ph.D., Kim Gratz, Ph.D., David DiLillo, Ph.D.
Continuing Medical Education Commercial Disclosure Requirement
I, Molly Franz, have no commercial relationships to disclose.
Emotion Dysregulation
• Emotion dysregulation is a multi-faceted construct
Lack of
awareness,
understanding,
and acceptance
of emotions
Unwillingness
to experience
emotional
distress (i.e.,
avoidance)
Difficulty
utilizing
appropriate
coping
strategies for
mitigating
emotions
(Gratz & Roemer, 2004; Gross, 1998; Seligowski & Orcutt, 2015)
Difficulty
modulating
physiological
reactions and
behaviors
when
distressed
• PTSD has been conceptualized as a
disorder characterized by deficits in
adaptive emotion regulation
• PTSD symptoms
• Intense distress at exposure to traumatic reminders
• Avoidance of distressing memories, thoughts, or feelings about the
traumatic event
• Irritable behavior and angry outbursts
• Persistent negative emotional state
• Persistent inability to experience positive emotions (i.e., emotional numbing)
(Frewin & Lanius, 2006; Litz, Orsillo, Kaloupek, & Weather, 2000)
PTSD and Emotion Dysregulation
• Growing literature demonstrates associations between emotion
dysregulation and PTSD; yet existing research is largely cross-sectional.
• Prospective research is rare but suggests that emotion regulation prior to
trauma plays a role in the development and maintenance of PTSD.
• Emotion regulation difficulties prior to a mass shooting prospectively predicted
PTSD symptoms in the acute aftermath of the shooting, and eight months
later.
• Similar work in different traumatized populations (e.g., victims of sexual
assault) is warranted.
(Bardeen et al., 2013; Marx & Sloan, 2005; Nightingale & Williams, 2000;
Seligowski et al., 2015)
Goal of the Present Study
• Expand upon prior literature by:
• Utilizing prospective study design
• Assessing impact of emotion dysregulation on sexual assault-related
PTSD, specifically
• Examining multiple facets of emotion dysregulation
• Therefore, we aim to…
Investigate the role of pre-trauma emotion regulation
difficulties in the development of PTSD following
exposure to sexual assault.
Sample
• Taken from a larger NICHD-funded longitudinal study on
emotion dysregulation and sexual revictimization among
young women (N=491) in the community.
• Study criteria: Among women who reported experiencing a
new incident of sexual assault at a given wave, prior wave
emotion dysregulation was examined as a prospective
predictor of sexual assault-related PTSD symptoms.
• 73 women met criteria for inclusion
Sample Demographics
• Age: 18-25 (M = 21.5, SD = 2.22)
• Race/Ethnicity: Primarily white (65.8%) or African American (26%). Other
races/ethnicities represent less than 5% of sample.
• Education: Half the sample were full-time students (48.6%).
• Months between pre- and post-assessment: 1.24 to 21.05 months (M = 5.52,
SD = 3.40)
• Prior victimization: The majority of the sample (91%) experienced childhood
sexual abuse or adult sexual assault prior to the index assault.
Measures
Emotion Regulation Measures
• Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004)
• Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007)
• Affect Intensity Measure (AIM; Larsen, 1984) – Mean negative
intensity/reactivity scale used in analyses.
• The Emotion Amplification and Reduction Scales (TEARS;
Hamilton et al., 2009) – Emotion Reduction scale used in the
current study.
• Difficulties in Emotion Regulation (DERS; Gratz & Roemer, 2004)
Measures (cont).
• Posttraumatic Stress Disorder Checklist for DSM-IV (PCL-C; Blanchard
et al., 1996)
• Severity of Index Sexual Assault: Computed by summing degree of
force used (e.g., verbal tactics, physical force), and severity of acts
(e.g., fondling only, oral sex, vaginal/anal penetration).
• Prior Victimization: Prior experience of child sexual abuse or adult
sexual assault.
Data analytic approach
• A structural equation model using maximum likelihood estimation with
robust standard errors (MLR) was estimated using Mplus 7 software
(Muthén & Muthén, 2010).
• Confirmatory factor analysis was conducted to determine the fit of the
measurement model.
• Measurement and structural models were tested simultaneously.
• The Comparative Fit Index (CFI), the Root Mean Square Error of
Approximation (RMSEA), and the Standard Root Mean Residual (SRMR)
were used to assess global fit.
(Bentler, 1990; Browne & Cudeck, 1993; Byrne, 2001; Hu & Bentler, 1999)
Data Analytic Approach
Three latent variables based on prominent models of emotion dysregulation.
• Acknowledgement of Emotions
• (1) DERS –Awareness, (2) DERS –Clarity, (3) DERS – Nonacceptance, (4) AAQ
• Experience of Emotions
• (1) ASI, (2) AIM-Negative emotion/negative reactivity, (3) TEARS-Reduction
• Management of Emotions
• (1) DERS—Limited access to strategies, (2) DERS—Impulse control
difficulties (3) DERS—Difficulties engaging in goal-directed behaviors
Because these three factors were expected to load onto a general construct of
emotion regulation, we simultaneously fit a second order latent variable.
Measurement
Model
CFI = .945
SRMR = .060
RMSEA = .096
Structural
Model
CFI = .929
SRMR = .063
RMSEA = .082
Discussion
•
Consistent with prior research, greater emotion dysregulation prior to a sexual assault
incident prospectively predicted greater PTSD symptoms following the event.
•
Reflects a vulnerability model of PTSD – individuals with poor emotion regulation have a
preexisting vulnerability to PTSD symptoms following trauma exposure.
•
Although we derived indicators of emotion dysregulation that loaded highly onto
conceptually derived factors, results suggest that different facets of emotion regulation
may have tapped into the same construct.
(Aldao, Nolen-Hoeksema, & Schweizer, 2010; Bardeen et al., 2013; Elwood, Hahn,
Olatunji, & Williams, 2009; Seligowski et al., 2015)
Discussion
• Clinical Implications: Improving emotion regulation skills early on,
particularly for those at heightened risk (e.g., military, first
responders, college freshman) could help mitigate the impact of
trauma exposure on PTSD development.
• Limitations: Greater sample sizes are preferred for latent variable
analyses. Our small N may have resulted in less stable and less
robust estimates of effects.
• Future Directions: Moderation and mediation analyses may reveal
important mechanisms or conditions under which emotion
dysregulation predicts PTSD symptoms.
Thank you!
• Molly Franz, M.A. (University of Nebraska-Lincoln)
• [email protected]