A latent profile analysis of moral emotions following moral transgressions.

OBJECTIVE: Moral transgressions (MTs), events that violate one's moral code, are associated with the moral emotions of guilt and shame. However, there may be different patterns by which people experience guilt and shame that affect distress following MTs. METHOD: Undergraduates (N = 1371) exposed to an MT completed self-report assessments. This study used latent profile analysis (LPA) to examine profiles based on guilt cognitions, internalized shame, and distress in relation to a reported MT. Cognitive flexibility, years since the MT, and deliberate and intrusive rumination were examined as variables to determine how these factors predicted profile membership. RESULTS: Results from the LPA revealed a three-profile solution: a low moral distress profile (n = 1002), a moderate moral distress profile (n = 262), and a shame prominent profile (n = 107). Results indicated that higher levels of deliberate and intrusive rumination and lower levels of cognitive flexibility significantly increased the likelihood of belonging to the moderate moral distress or shame prominent profiles compared to the low moral distress profile. Higher levels of intrusive rumination and lower levels of cognitive flexibility also significantly increased the likelihood of belonging to the shame prominent profile over the moderate distress profile. CONCLUSION: Three different profiles emerged, with the shame prominent profile being driven primarily by internalized shame. Results suggest that intrusive rumination and cognitive inflexibility are risk factors to experiencing adverse responses to MTs.

Brain derived neurotrophic factor and treatment outcomes among veterans attending an intensive treatment program for posttraumatic stress disorder.

Brain derived neurotrophic factor (BDNF) may play an important role in the success of treatment for posttraumatic stress disorder (PTSD). Pre- and post-treatment blood samples were analyzed for 40 veterans who completed a 3-week intensive outpatient treatment for PTSD. The treatment included Cognitive Processing Therapy, mindfulness, and yoga as core treatment components. PTSD symptoms were assessed at pre-treatment, post-treatment, and 3-month follow-up. Participants reported large decreases in PTSD symptoms from pre-to post-treatment (d = 1.46, p < 0.001) and pre-treatment to 3-month follow-up (d = 0.91, p < 0.001). Unexpectedly, participants demonstrated a decrease in BDNF from pre-to post-treatment (d = 0.64, p < 0.001). Changes in BDNF from pre-to post-treatment were not significantly associated with PTSD symptom improvement. However, higher levels of post-treatment BDNF were significantly associated with lower PTSD symptoms at 3-month follow-up (n = 27, r = -0.57, p = 0.002) and greater improvements in PTSD symptoms from pre-treatment to 3-month follow-up (n = 27, r = 0.50, p = 0.008). Higher levels of post-treatment BDNF may facilitate the long-term success of intensive PTSD treatment. Further research with larger samples is needed to evaluate the processes by which BDNF may affect consolidation of improvements after completion of PTSD treatment.

Dianne L. Chambless (1948-2023).

Dianne L. Chambless, professor emerita of psychology at the University of Pennsylvania, died on July 14, 2023. Dianne received her doctorate in clinical psychology from Temple University in 1979. She then served on the faculties of the University of Georgia, American University, and the University of North Carolina Chapel Hill before going to the University of Pennsylvania for the final 17 years of her career. Dianne was a highly respected anxiety researcher, an award winning mentor, a leading advocate for the importance of basing clinical care on the best available research evidence, and a champion of women in academia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Differential Associations of Childhood Abuse and Neglect With Adult Autonomic Regulation and Mood-Related Pathology.

OBJECTIVE: This study assessed whether different types of childhood maltreatment (i.e., abuse versus neglect) had differential relationships with heart rate variability (HRV) and baroreflex sensitivity. In addition, this study tested the indirect effect of maltreatment subtypes on adult mood-related psychopathology via HRV, and whether these relationships differed in those with HRV above and below established clinical cutoffs. METHODS: Secondary analysis was performed using the Midlife Development in the United States data set ( N = 967; Mage = 55; 58.4% female; 75.9% White). In a single study visit, autonomic measurements were captured at rest, during two cognitive stressors (Stroop and MATH tasks), and during recovery after the tasks. Structural equation modeling was used to assess the relationships between key variables during all three measurement periods. RESULTS: Resting pathways from abuse and neglect to baroreflex sensitivity were nonsignificant, as was the pathway from HRV to mood-related pathology. Notably, greater abuse was significantly predictive of lower HRV (standardized ß = -0.42, p = .009), whereas greater neglect was significantly predictive of higher HRV (standardized ß = 0.32, p = .034). In addition, higher abuse was significantly predictive of greater adult symptoms (standardized ß = 0.39, p < .001), but neglect was not found to be related to adult mood-related pathology. Significant relationships between variables were only found in those with low HRV. CONCLUSIONS: Although cross-sectional, our findings provide further evidence that low HRV may be a transdiagnostic endophenotype for mood-related pathology and suggest that greater differentiation between abuse and neglect is appropriate when investigating the impact of childhood maltreatment on adult health outcomes.

The Past, Present, and Future of Psychotherapy Manuals: Protocol for a Scoping Review.

BACKGROUND: Psychotherapy manuals are critical to the dissemination of psychotherapy treatments. Psychotherapy manuals typically serve several purposes, including, but not limited to, establishing new psychotherapy treatments, training providers, disseminating treatments to those who deliver them, and providing guidelines to deliver treatments with fidelity. Yet, the proliferation of psychotherapy manuals has not been well-understood, and no work has aimed to assess or review the existing landscape of psychotherapy manuals. Little is known about the breadth, scope, and foci of extant psychotherapy manuals. OBJECTIVE: This scoping review aims to identify and explore the landscape of existing book-based psychotherapy manuals. This review aims to specify the defining characteristics (ie, foci, clinical populations, clinical targets, treatment type, treatment modality, and adaptations) of existing book-based psychotherapy manuals. Further, this review will demonstrate how this information, and psychotherapy manuals more broadly, has changed over time. This project aims to make a novel contribution that will have critical implications for current methods of developing, aggregating, synthesizing, and translating knowledge about psychotherapeutic treatments. METHODS: This scoping review will review book-based psychotherapy manuals published from 1950 to 2022.This scoping review will be informed by guidance from the Joanna Briggs Institute Scoping Review Methodology Group and prior scoping reviews. Traditional search and application programming interface-based search methods will be used with search terms defined a priori to identify relevant results using 3 large book databases: Google Books, WorldCat, and PsycINFO. This review will leverage machine learning methods to enhance and expedite the screening process. Primary screening of results will be conducted by at least 2 authors. Data will be extracted and double-coded by research assistants using an iteratively defined codebook. RESULTS: The search process produced 78,600 results, which were then iteratively deduplicated. Following deduplication, 50,583 results remained. The scoping review is expected to identify common elements of psychotherapy manuals, establish how the foci and content of manuals have changed over time, and illustrate coverage and gaps in the landscape of psychotherapy manuals. Results from this scoping review will be critical for future work focused on developing, aggregating, synthesizing, and disseminating knowledge about psychotherapeutic treatments. CONCLUSIONS: This review will provide knowledge about the vast landscape of psychotherapy manuals that exist. Findings from this study will inform future efforts to develop, aggregate, synthesize, and translate knowledge about psychotherapeutic treatments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47708.

A mixed methods study of moral distress among frontline nurses during the COVID-19 pandemic.

OBJECTIVE: The study's purpose was to develop an understanding of factors affecting moral distress among nurses during the COVID-19 pandemic. METHOD: California-licensed, registered nurses who cared for COVID-19 patients for at least 3 months were recruited for an explanatory concurrent mixed methods study. Data are derived from the first of two surveys administered 3 months apart, including open-ended questions. RESULTS: Variables with significant bivariate correlations were included as simultaneous predictors in a linear regression model predicting moral distress. The overall model was significant, explaining a substantial portion of the variance in moral distress, but results showed only organizational support and institutional betrayal uniquely predicted moral distress. Three qualitative themes were identified: Ethical Violations in Care, Institutional Betrayal, and Traumatic Strain. The impacts of organizational support and institutional betrayal on nurses' moral distress are important findings in both datasets. CONCLUSIONS: Findings provide insights into how nurses' experiences affected their feelings about work. Participants indicated feeling disregarded by management and institutional structures, indicating potential means of slowing the rates at which nurses plan to leave bedside practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing the existence of trauma-related diagnostic overshadowing in adult populations.

OBJECTIVE: Previous research with youth has shown that clinicians tend to diagnose and treat posttraumatic stress disorder (PTSD) in trauma-exposed clients, even when clinical presentations indicate that PTSD is not the primary diagnosis. The current study sought to examine this trauma-related diagnostic overshadowing bias in adult cases across different types of trauma exposure. METHOD: Mental health professionals (N = 232) reviewed two vignettes describing an adult seeking treatment for either obsessive-compulsive disorder (OCD) symptoms or substance use disorder (SUD) symptoms (target disorders). Each participant was randomly assigned to one vignette in which one client endorsed exposure to trauma (i.e., sexual trauma or physical trauma) and one vignette in which the client reported no trauma exposure. Following each vignette, participants responded to questions related to the diagnosis and treatment of the client. RESULTS: In both cases, participants were significantly less likely to choose the target diagnosis and treatment and more likely to choose a PTSD diagnosis and trauma treatment when trauma exposure was present in the vignettes. Evidence for the bias was strongest for vignettes that contained sexual trauma compared to vignettes that contained physical trauma. Evidence for the bias was also more consistent in the OCD case compared to the SUD case. CONCLUSIONS: Results indicate evidence for the existence of trauma-related diagnostic overshadowing in adult populations, though the strength of this bias may be dependent on aspects of the trauma and overall clinical presentation. More work is needed to understand factors that may impact the presence of this bias. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Geolocation Patterns, Wi-Fi Connectivity Rates, and Psychiatric Symptoms Among Urban Homeless Youth: Mixed Methods Study Using Self-report and Smartphone Data.

BACKGROUND: Despite significant research done on youth experiencing homelessness, few studies have examined movement patterns and digital habits in this population. Examining these digital behaviors may provide useful data to design new digital health intervention models for youth experiencing homelessness. Specifically, passive data collection (data collected without extra steps for a user) may provide insights into lived experience and user needs without putting an additional burden on youth experiencing homelessness to inform digital health intervention design. OBJECTIVE: The objective of this study was to explore patterns of mobile phone Wi-Fi usage and GPS location movement among youth experiencing homelessness. Additionally, we further examined the relationship between usage and location as correlated with depression and posttraumatic stress disorder (PTSD) symptoms. METHODS: A total of 35 adolescent and young adult participants were recruited from the general community of youth experiencing homelessness for a mobile intervention study that included installing a sensor data acquisition app (Purple Robot) for up to 6 months. Of these participants, 19 had sufficient passive data to conduct analyses. At baseline, participants completed self-reported measures for depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]). Behavioral features were developed and extracted from phone location and usage data. RESULTS: Almost all participants (18/19, 95%) used private networks for most of their noncellular connectivity. Greater Wi-Fi usage was associated with a higher PCL-5 score (P=.006). Greater location entropy, representing the amount of variability in time spent across identified clusters, was also associated with higher severity in both PCL-5 (P=.007) and PHQ-9 (P=.045) scores. CONCLUSIONS: Location and Wi-Fi usage both demonstrated associations with PTSD symptoms, while only location was associated with depression symptom severity. While further research needs to be conducted to establish the consistency of these findings, they suggest that the digital patterns of youth experiencing homelessness offer insights that could be used to tailor digital interventions.

Differential associations of rumination and cognitive flexibility with guilt and shame following potentially morally injurious events.

BACKGROUND: Guilt and shame are common moral emotions following potentially morally injurious events (PMIEs), which involve events that violate one's deeply held moral values. However, not all individuals will experience guilt and shame following PMIEs and the mechanisms by which PMIEs lead to guilt and shame are not well understood. This study set out to examine the role of event-related intrusive rumination, event-related deliberate rumination, cognitive flexibility, and their interactions, in predicting PMIE-related guilt and shame. METHODS: A subsample of undergraduate participants exposed to an objective PMIE and endorsing a subjective PMIE (N = 323) completed self-report assessments. RESULTS: Higher levels of event-related intrusive rumination and event-related deliberate rumination and lower levels of cognitive flexibility were associated with higher levels of PMIE-related shame. Only higher levels of event-related deliberate rumination were associated with greater PMIE-related guilt. Moreover, the predictors explained much greater variance in PMIE-related shame (R2Adj = 0.44) than PMIE-related guilt (R2Adj = 0.05). There was no significant interaction between event-related rumination and cognitive flexibility in predicting PMIE-related guilt or shame. LIMITATIONS: This study was cross-sectional, the sample was mostly female, and all data was collected via self-report. Longitudinal studies are needed to explore these potential mechanistic processes. CONCLUSIONS: Our findings suggest that differential pathways may affect whether individuals experience guilt or shame following PMIEs. Rumination and cognitive flexibility may be valuable clinical targets for interventions aimed at addressing PMIE-related shame.

Sleep timing, chronotype, and posttraumatic stress disorder: An individual participant data meta-analysis.

Sleep disturbance is a major component of posttraumatic stress disorder (PTSD). The role of circadian disruption is largely overlooked, though many PTSD studies collect proxy markers of circadian timing. This individual participant data (IPD) meta-analysis examined the correlation between sleep timing / chronotype and PTSD severity among individuals diagnosed with PTSD, the standardized mean difference in sleep timing / chronotype for individuals with and without PTSD, and moderators of these relationships. A systematic search was conducted; authors provided IPD for 27 studies and aggregate data for 16 studies (3,011 participants with PTSD; 2,703 participants without PTSD). Two-step meta-analyses were conducted using a random-effects multivariate approach with robust variance estimation. Bedtime and wake time were not significantly associated with PTSD symptoms or diagnosis. Less total sleep time / time in bed was weakly associated with greater PTSD symptoms. Moderator analyses revealed that effect sizes were stronger in certain populations and when using wrist actigraphy to measure sleep timing; however, gap maps revealed few studies in moderator categories with the strongest effects. Only two studies measured chronotype, prohibiting strong conclusions. Our findings indicate that the relationship between sleep timing and PTSD is weak; however, key gaps in the literature warrant further study.

Exploring how positive and negative social exchanges relate to posttraumatic stress disorder severity among previously deployed men service members/veterans.

OBJECTIVE: Research in civilians and women shows negative social support is more deleterious for posttraumatic stress disorder (PTSD) symptoms than are the buffering effects of positive social support. However, this is understudied in male military samples. Moreover, appraisals of social support appear to be the mechanism of the association of social support type and PTSD severity, but appraisals as mediators have not been explored in military samples. METHOD: Previously deployed male service members/veterans (SM/Vs; n = 333) completed a demographic inventory, the Positive and Negative Social Exchange Scale, which assesses positive and negative social support and their appraisals, and the PTSD Checklist-5. Path analyses examined associations of positive and negative social support with PTSD severity and whether appraisals mediated these associations. RESULTS: The magnitude of the association of negative social support and PTSD symptom severity (standardized estimate = .33; SE = .06, p < .001) was statistically greater than the association of positive social support and PTSD symptom severity (standardized estimate = -.26; SE = .06, p < .001). Higher positive support was associated with higher appraisals, and in turn, higher appraisals were associated with lower PTSD severity, suggesting mediation. In contrast, the association of negative social support with PTSD was direct. CONCLUSION: Causality cannot be inferred. Positive support exhibits a weaker relationship with PTSD because its effect is dependent on how an individual appraises the support whereas negative support has a direct relationship with PTSD regardless of appraisals. Findings suggest positive support interventions should focus on individual perceptions whereas negative support interventions should focus on decreasing how often these interactions occur. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Posttraumatic Cognitions Differ Between Men and Women after Military Sexual Assault Revictimization in Their Contribution to PTSD Symptoms.

Sexual revictimization is heightened among military service members and veterans and is associated with greater posttraumatic stress symptoms (PTSS) and severity. The heightened distress following revictimization may be due to posttraumatic cognitions (PTC), which include negative beliefs about the self and world, and self-blame. Moreover, it is unclear whether men and women experience different levels of PTC. The current study tested PTC (overall and subdomains) as a possible mediator between sexual revictimization and PTSS severity, and gender as a possible moderator of these associations. Revictimization was defined across time periods (military sexual assault [MSA] only vs. premilitary sexual trauma + MSA) and in military rape frequency (0, 1, 2+). Participants were 400 (n = 200 [50%] male) service members/veterans with a history of MSA and completed online, anonymous, self-report questionnaires. PTC mediated the association between revictimization and PTSS severity. A significant interaction of gender suggested that men reported high overall PTC and PTC about the self regardless of revictimization; by contrast, overall PTC and PTC about the self were lower for women in response to MSA only and increased with revictimization. Results also showed men were more sensitive to PTC about self-blame as it pertains to more severe PTSS compared to women. There were no unique gender interactions when assessing revictimization by rape frequency, although PTC (overall, all subdomains) significantly mediated the association between rape frequency and PTSS severity. PTC may be a beneficial target when treating PTSS in men, and may be especially heightened in women who have experienced revictimization.

Sentenced to shame: Moral injury exposure in former lifers.

OBJECTIVE: A significant increase in the release of individuals who served life sentences (i.e., lifers) in California has created the opportunity to study aspects of their psychological wellness for the first time. Moral injury may be a particularly relevant factor to consider in this population but has not been previously studied. This study is the first to explore the concept of moral injury within a currently or formerly incarcerated population. METHOD: Former lifers currently in reentry in California (N = 41) completed a survey that measured their moral injury exposure (MIE), MIE-related guilt, MIE-related shame, MIE-related rumination, religiosity, attempts at making amends, and flourishing. RESULTS: As expected, a high rate of lifetime MIEs was endorsed (97.6%). Events linked to life sentence crimes (75.6%) and time in prison (56.1%) were very common. Lower levels of MIE-related shame (r = -.58, p < .01) and higher levels of religiosity (r = .35, p < .05) were significantly associated with greater flourishing. By contrast, degree of MIE exposure, MIE-related guilt, and MIE-related rumination, and making amends were all weakly associated with flourishing. CONCLUSION: Our results highlight that MIE is pervasive in this population and extends beyond life sentence crimes. Moreover, our findings suggest that it is lifers' self-concept following MIEs that appears to affect well-being upon release, rather than the extent and nature of moral injury exposure. Further research exploring moral injury in incarcerated and formerly incarcerated populations is needed to improve their well-being and chances of successful reentry. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Morning light treatment for traumatic stress: The role of amygdala reactivity study protocol.

BACKGROUND: Exposure to trauma can result in various mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although psychotherapies and pharmacotherapies exist for the treatment of these disorders, many individuals fail to receive treatment and among those who do, many remain symptomatic. Therefore, it is critical to continue developing new interventions for traumatic stress that target underlying mechanisms of pathology and offer a safe and acceptable alternative to current treatments. Morning light treatment has good potential as a novel non-invasive, low risk treatment for traumatic stress. Evidence suggests that morning light may improve traumatic stress by reducing reactivity in the amygdala, a brain region implicated in the pathophysiology of PTSD and anatomically linked to circadian photoreceptors in the eye. METHODS: In this study, we aim to establish a significant dose-response relationship between duration of morning light treatment and reduction in amygdala reactivity among individuals with traumatic stress symptoms (NCT# 04117347). Using a transdiagnostic approach, sixty-six individuals with a history of a DSM-5 criterion A trauma and traumatic stress symptoms will be recruited to participate in a 5-week study. Participants will be randomized across three treatment arms based on morning light treatment duration: 15-minutes, 30-minutes, or 60-minutes of light treatment per day for four weeks. To evaluate amygdala activity, participants will undergo fMRI at pre-treatment, mid-treatment, and post-treatment. Participants will also complete clinical assessments and self-report measures of PTSD, depression, and anxiety at pre-treatment, mid-treatment, and post-treatment. DISCUSSION: Morning light therapy may be an acceptable, feasible, and effective treatment for individuals suffering from traumatic stress. Identifying mechanistically relevant targets, and the doses needed to impact them, are critical steps in developing this new treatment approach for the sequelae of traumatic stress.

Abnormal intestinal milieu in posttraumatic stress disorder is not impacted by treatment that improves symptoms.

Posttraumatic stress disorder (PTSD) is a psychiatric disorder, resulting from exposure to traumatic events. Current recommended first-line interventions for the treatment of PTSD include evidence-based psychotherapies, such as cognitive processing therapy (CPT). Psychotherapies are effective for reducing PTSD symptoms, but approximately two-thirds of veterans continue to meet diagnostic criteria for PTSD after treatment, suggesting there is an incomplete understanding of what factors sustain PTSD. The intestine can influence the brain and this study evaluated intestinal readouts in subjects with PTSD. Serum samples from controls without PTSD (n = 40) from the Duke INTRuST Program were compared with serum samples from veterans with PTSD (n = 40) recruited from the Road Home Program at Rush University Medical Center. Assessments included microbial metabolites, intestinal barrier, and intestinal epithelial cell function. In addition, intestinal readouts were assessed in subjects with PTSD before and after a 3-wk CPT-based intensive treatment program (ITP) to understand if treatment impacts the intestine. Compared with controls, veterans with PTSD had a proinflammatory intestinal environment including lower levels of microbiota-derived metabolites, such as acetic, lactic, and succinic acid, intestinal barrier dysfunction [lipopolysaccharide (LPS) and LPS-binding protein], an increase in HMGB1, and a concurrent increase in the number of intestinal epithelial cell-derived extracellular vesicles. The ITP improved PTSD symptoms but no changes in intestinal outcomes were noted. This study confirms the intestine is abnormal in subjects with PTSD and suggests that effective treatment of PTSD does not alter intestinal readouts. Targeting beneficial changes in the intestine may be an approach to enhance existing PTSD treatments.NEW & NOTEWORTHY This study confirms an abnormal intestinal environment is present in subjects with PTSD. This study adds to what is already known by examining the intestinal barrier and evaluating the relationship between intestinal readouts and PTSD symptoms and is the first to report the impact of PTSD treatment (which improves symptoms) on intestinal readouts. This study suggests that targeting the intestine as an adjunct approach could improve the treatment of PTSD.

Rates and correlates of well-being among youth experiencing homelessness.

Mental health concerns have been well studied among youth experiencing homelessness, yet few studies have explored factors that contribute to well-being in this population. The current cross-sectional study examined rates and correlates of well-being among youth experiencing homelessness. This is a descriptive, secondary analysis of the baseline data from a clinical intervention study. Ninety-nine youth (aged 16-25) who were experiencing homelessness were recruited in Chicago. Approximately 40% of the sample reported average or above average well-being relative to existing benchmarks. Having medical insurance, a mobile phone, and a history of more severe childhood trauma were unique cross-sectional predictors of worse well-being (all ps < 0.034). A significant portion of our sample experienced well-being. Having access to certain resources may be counterintuitive indicators of poorer well-being among youth experiencing homelessness, perhaps because they are indicators of greater need or increased social comparison among these youth.

"You're going to look at me differently": A qualitative study of disclosure experiences among survivors of military sexual assault.

Most survivors of sexual assault who disclose their experience do so within their social network. Prior research on disclosure among individuals who experience sexual trauma has mainly focused on childhood sexual abuse, college-aged women, or disclosure to formal sources of support (e.g., treatment providers). There is limited research on disclosure among veteran survivors of military sexual assault (MSA). The current qualitative study aimed to explore the disclosure experiences of treatment-seeking survivors of MSA. Participants were 17 veterans (n = 13 women, n = 4 men), aged 33-65 years, who reported experiencing MSA. During semistructured interviews, participants were asked about their experiences disclosing MSA to informal support persons (e.g., family members, partners, friends). A narrative thematic analysis identified 11 themes that emerged throughout different aspects of the disclosure, including (a) preparation and reason for disclosure (reactive or spontaneous disclosures, disclosure as an explanation/obligation), (b) expectations about the disclosure experience (no expectations, negative expectations grounded in socialized beliefs, positive expectations based on specific relationships, mismatch between experience and expectation), (c) the actual disclosure experience (negative experiences of personalization, supportive responses, share shame), and (d) military context (disclosing to another member of the military, reporting dynamics). Additional subthemes were nested within these categories. The findings indicated common experiences across participants, particularly regarding disclosure rationale. Key differences were largely influenced by contextual factors (e.g., response of the disclosure recipient). These findings hold implications for clinicians working with survivors of MSA who are preparing for and coping with the consequences of disclosure.

The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis.

Background: Betrayal traumas have a particularly deleterious effect on mental health. Although social support is a robust predictor of posttraumatic stress disorder (PTSD) symptom severity, it is not clear what factors may impact this relationship among betrayal trauma survivors. Objective: This study sought to describe the association between social support and PTSD symptom severity among survivors of betrayal trauma and examine whether methodological, sample, trauma, and social support characteristics moderated this association. Method: A comprehensive search identified 29 studies that assessed the cross-sectional association between PTSD symptom severity and social support among 6,510 adult betrayal trauma survivors. Results: The average effect size (r = -.25; 95% CI: -.30, -.20) was small to medium, with significant heterogeneity between studies (I2 = 71.86). The association between PTSD and social support was stronger when the trauma was perpetrated by a romantic partner compared to mixed perpetrators, even after accounting for covariates. There was also a significant effect of support type depending on whether the support was provided in the context of trauma disclosure. Specifically, positive reactions to trauma disclosure were not associated with PTSD symptoms whereas general positive social support (not disclosure focused) was associated with fewer PTSD symptoms. Negative reactions to trauma disclosure were associated with more PTSD symptoms. None of the included studies measured general negative social support outside of trauma disclosure. Conclusions: Our findings suggest that social support may be a particularly important buffer against PTSD symptoms when experiencing traumatic betrayal by an intimate partner. Additionally, our results suggest that social support interventions for those experiencing betrayal trauma should focus on reducing negative responses to disclosure and bolstering general satisfaction with social support.

Antecedentes: Los traumas de traición tienen un efecto particularmente perjudicial sobre la salud mental. Aunque el apoyo social es un fuerte predictor de la severidad de los síntomas del trastorno de estrés postraumático (TEPT), no está claro qué factores pueden afectar esta relación entre los sobrevivientes de traumas de traición.Objetivo: Este estudio buscó describir la asociación entre el apoyo social y la severidad de los síntomas del TEPT entre los sobrevivientes de trauma de traición y examinar si las características metodológicas, muestrales, de trauma y de apoyo social moderaron esta asociación.Método: Una búsqueda exhaustiva identificó 29 estudios que evaluaron la asociación transversal entre la gravedad de los síntomas de TEPT y el apoyo social entre 6.510 adultos sobrevivientes de trauma de traición.Resultados: El tamaño del efecto promedio (r = −.25; IC del 95%: −.30, −.20) fue de pequeño a mediano, con heterogeneidad significativa entre los estudios (I2 = 71.86). La asociación entre el TEPT y el apoyo social fue más fuerte cuando el trauma fue perpetrado por una pareja romántica en comparación con perpetradores mixtos, incluso después de tener en cuenta las covariables. También hubo un efecto significativo del tipo de apoyo dependiendo de si el apoyo se proporcionó en el contexto de la revelación del trauma. Específicamente, las reacciones positivas a la revelación del trauma no se asociaron con síntomas de TEPT, mientras que el apoyo social positivo general (no enfocado en la revelación) se asoció con menos síntomas de TEPT. Las reacciones negativas a la revelación del trauma se asociaron con más síntomas de TEPT. Ninguno de los estudios incluidos midió el apoyo social negativo general fuera de la revelación del trauma.Conclusiones: Nuestros hallazgos sugieren que el apoyo social puede ser un amortiguador particularmente importante contra los síntomas del TEPT cuando se experimenta una traición traumática por un compañero íntimo. Además, nuestros resultados sugieren que las intervenciones de apoyo social para quienes experimentan el trauma de traición deben centrarse en reducir las respuestas negativas a la revelación y reforzar la satisfacción general con el apoyo social.

Sleep quality and outcome of exposure therapy in adults with social anxiety disorder.

INTRODUCTION: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may negatively affect exposure therapy outcomes. Poor sleep may impair memory and learning, and thus compromise fear extinction learning thought to take place in exposure therapy. We examined poor sleep as a predictor of exposure therapy outcomes for SAD and the moderating role of d-cycloserine (DCS) on this relationship. METHODS: Participants were 152 individuals with a primary diagnosis of SAD. As part of a randomized clinical trial evaluating the efficacy of DCS for enhancing the effects of exposure therapy, they completed self-report baseline measure of sleep quality, and self-report sleep diaries assessing sleep duration (total sleep time [TST]) and sleep quality the nights before and after treatment sessions. RESULTS: Poorer baseline sleep quality was significantly associated with slower improvement over time and worse symptom outcomes at the end of treatment and follow-up after controlling for baseline symptoms of depression and social anxiety. Greater TST the night before treatment predicted lower SAD symptoms at the next session, after controlling for symptoms at the previous session. There was no relation between prior or subsequent night sleep quality on symptoms at the next session. No associations were moderated by DCS. CONCLUSIONS: We replicated and extended findings indicating that poor sleep quality is associated with poorer exposure therapy outcomes for SAD. Assessing for sleep difficulties before treatment initiation and incorporating sleep interventions into treatment may enhance exposure therapy outcomes for SAD.

Maternal expressions of positive emotion for children predicts children's respiratory sinus arrhythmia surrounding stress.

The aim of this study is to assess whether positive emotional exchanges (i.e., emotion coregulation) within the mother-child dyad play a protective role in children's physiological response to a distressing task. Specifically, we test whether positive emotion coregulation among mothers and their preschool-aged children is associated with children's respiratory sinus arrhythmia (RSA) at baseline, during, and following a frustration task. One hundred Singaporean mother-child dyads (Mchildage  = 3.5 years) participated in a standardized "Laughing Task" in which positive emotional constructs were measured. Children also participated in a frustration task while RSA was continuously monitored. Hierarchical linear regressions revealed that greater maternal positive emotional responses to children were associated with child RSA at baseline and in recovery from frustration, but not during frustration. These findings have implications for the important role that positive emotion responsivity from mothers may play in children's developing autonomic response systems, and underscore the need for longitudinal work on this topic.