Impact of dissociation on exposure therapy for PTSD outcomes and Adherence among U.S. Military service members.

Emotional engagement is necessary for successful exposure therapy for posttraumatic stress disorder (PTSD), but dissociation is considered a barrier to emotional engagement. Virtual reality exposure therapy (VRE) uses multi-sensory virtual environments to increase emotional engagement during exposure therapy, and average treatment outcomes are comparable to traditional exposure therapy. However, individual factors (e.g., depression) can predict differential responses to VRE. Studies have yet to investigate whether VRE would be more effective in treating patients with dissociation compared to traditional PE. This secondary analysis of a randomized clinical trial explores whether dissociation predicts treatment outcomes to exposure therapy among active-duty soldiers (N = 108) diagnosed with PTSD. We also examine whether individuals reporting dissociative symptoms demonstrated differential treatment responses to VRE and PE. Results indicated a significant two-way interaction between dissociation and time in treatment, such that dissociation blunted the negative relationship between time and PTSD symptoms. Dissociation was not associated with treatment session attendance or drop out. Results also revealed no significant effect of treatment group (PE or VRE) on the relationship between dissociation and PTSD symptoms. Findings contribute to a body of literature supporting the potential clinical and research utility of a dissociative subtype of PTSD.

Disgust uniquely predicts coping and interpersonal processes beyond anxiety and dysphoria in the context of naturalistic stressors.

BACKGROUND: Disgust is theorized to serve a unique function of motivating avoidance of noxious stimuli and setting interpersonal boundaries to prevent contamination. Research has established the relevance of disgust to OCD, posttraumatic stress, and phobias, suggesting transdiagnostic features. However, research has not always accounted for overlap of disgust with other negative emotions, obscuring unique contributions. Moreover, studies have not disentangled between-person (mean levels) and within-person (state) effects. The present study examined within- and between-person relationships of disgust, anxiety, and dysphoria with responses to daily social stressors. We expected disgust would uniquely predict cognitive avoidance and boundary-setting interpersonal behavior. METHOD: Individuals (N = 159) meeting ADIS-V anxiety/depressive disorder criteria (n = 55) and healthy controls (n = 104) completed online journals about naturalistic social stressors over five weeks (1,923 records), reporting disgust, anxiety, dysphoria, and responses to social stressors. RESULTS: As expected, disgust uniquely predicted lower acceptance, greater thought suppression, greater self-assertion, and less prosocial behavior, above and beyond anxiety and dysphoria. Several disgust effects were present at both between- and within-person levels, suggesting the relevance of both mean disgust and state fluctuations. CONCLUSIONS: Results demonstrate unique relevance of disgust for how individuals respond to social stressors.

Gratitude is positively associated with quality of life in multiple sclerosis.

PURPOSE/OBJECTIVE: Individuals diagnosed with multiple sclerosis (MS) often experience decreased quality of life (QoL), in part attributable to fatigue, depression (Benedict et al., 2005), and cognitive dysfunction (Cutajar et al., 2000). Beyond these well-established predictors, the positive trait of gratitude-attentiveness to positive features in one's life-has predicted QoL in the context of other chronic illnesses. However, relatively little research has examined the relevance of gratitude as a contributor to QoL in MS. The purpose of the present study was (a) to test whether trait gratitude would predict QoL in MS, above and beyond known predictors (e.g., perceived and objectively assessed cognitive dysfunction, fatigue, and depression symptoms), and (b) to test whether gratitude would buffer (i.e., moderate) the effects of these predictors on QoL. Research Method/Design: This study employed a cross-sectional, single time-point design. Participants formally diagnosed with MS (N = 128) completed a short battery to assess cognitive function and self-report measures of depression, fatigue, perceived cognitive functioning, gratitude, and QoL. RESULTS: Consistent with hypotheses, gratitude uniquely predicted higher QoL beyond other predictors. In addition, gratitude buffered the effect of objective cognitive performance on QoL as expected, but did not interact with other predictors. CONCLUSIONS/IMPLICATIONS: These results suggest the need for further research into gratitude as a potential source of resilience for individuals with MS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).