Moderating effects of dysregulation and fear of positive emotions on the relationship between posttraumatic stress disorder symptoms and positive memory count

Exploring the co-occurrence of posttraumatic stress disorder symptoms and dysregulated positive emotion processes: A network analysis

Emerging research indicates an important role of positive emotion processes in posttraumatic stress disorder (PTSD) symptomatology. To extend this research, we utilized a network approach to examine associations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognition and mood [NACM], alterations in arousal and reactivity [AAR]) and dysregulated positive emotion processes (levels of positive affect, self-focused positive rumination, emotion-focused positive rumination, dampening, impulse control difficulties, difficulties engaging in goal-directed behaviors, nonacceptance of positive emotions). Specifically, we examined differential relations between PTSD symptom clusters and positive emotion processes, and symptoms that most strongly connected these constructs (i.e., communities). The sample included 191 trauma-exposed adults recruited from Amazon's MTurk ( Mage = 38.54 ± 10.99 years, 53.4 % women, 63.4 % with probable PTSD). A regularized Guassian Graphic Model consisting of four nodes representing the PTSD symptom clusters' community and seven nodes representing the positive emotion processes' community was generated. The strongest positive associations across communities were the NACM-dampening and the AAR-dampening edges. Bridge symptoms with the highest inter-community connectivity were dampening, AAR, intrusions, NACM, and impulse control difficulties. Overall, this study indicates the importance of incorporating positive emotion processes in the conceptualization of PTSD. Our results also highlight that dampening of positive emotions and difficulties with impulse control while experiencing positive emotions may be meaningful targets in PTSD treatment.

Posttraumatic stress symptoms and positive autobiographical memory characteristics in everyday life

Individuals with posttraumatic stress symptoms (PTSS) report difficulties engaging with positive autobiographical memories. Extending this line of research, we examined daily-level concurrent and lagged associations between PTSS severity and positive memory characteristics (vividness, coherence, accessibility, time perspective, sensory details, visual perspective, emotional intensity, sharing, distancing, and valence). The sample included 88 trauma survivors (Mage = 39.89 years, 59.1% female) who completed seven daily measures of PTSS and positive memory characteristics. Multilevel models examined concurrent and lagged associations between PTSS severity and positive memory characteristics. The results indicated that days with higher PTSS severity were associated with less accessibility, β = -.21, p < .001; less visual perspective, β = -0.13, p = .034; and lower positive valence of the memory, β = -.19, p = .003, as well as more emotional intensity associated with, β = .13, p = .041, and more distancing from, β = .21, p < .001, the memory. Supplemental lagged analyses indicated that higher previous-day PTSS severity was associated with more next-day distancing from, β = .15, p = .042, and sensory details of, β = .17, p = .016, the memory. Findings suggest that individuals with more severe PTSS have difficulties accessing positively valenced memories from a first-person perspective, are more distant from the recalled positive memory, and report more emotional intensity when retrieving the memory. Thus, improving access to and reducing distance from positive autobiographical memories, as well as addressing emotional intensity surrounding the retrieval of these memories, may be potential clinical targets for PTSS interventions.

Addressing challenges faced by young refugees in the Netherlands: Adapting problem management plus (PM+) with an emotional processing module

Young refugees face numerous challenges before, during, and after their journey, leading to higher rates of mental health issues such as depression, anxiety, and posttraumatic stress disorder. These problems often remain untreated due to barriers like limited services, stigma, and varied distress expressions. One effective scalable intervention that bridges this treatment gap is problem management plus (PM+), a transdiagnostic program delivered by trained nonspecialists. However, PM+ lacks a module directly targeting posttraumatic stress, which is a common problem in young refugees. This study presents the cultural and contextual adaptation process of PM+ for young refugees in the Netherlands that includes a newly developed emotional processing module. Qualitative data collection included free list interviews with youngsters (n = 33), key informant interviews with professionals (n = 9), policymakers (n = 5), key people from communities (n = 10), focus group discussions (n = 11) and one focused interview. A new module targeting distressing memories was developed and reviewed by experts (n = 14). Results supported protocol adaptations, including culturally and age-appropriate language, examples, illustrations and length. This research aims to develop feasible, culturally sensitive mental health interventions tailored to the unique needs of young refugees.

From posttraumatic stress symptoms to suicidal ideation among military veterans: Pathways founded on meaning in life and gratitude

Military veterans experience higher rates of suicidal ideation compared to nonveteran populations. Importantly, suicidal ideation often precedes and predicts fatal and nonfatal suicide attempts, and thus it is critical to better understand factors that increase risk for suicidal ideation to inform suicide prevention efforts in this population. One key predictor of suicidal ideation is exposure to traumatic experiences and their sequelae, particularly posttraumatic stress symptoms (PTSS). However, little work has explored how deficits in well-being contribute to this association among veterans. We tested two aspects of well-being-meaning in life and gratitude-as potential mechanisms underlying the pathway from PTSS to suicidal ideation among 7,388 men and women veterans who recently separated from service. A parallel mediation analysis revealed significant paths from more severe PTSS to more frequent suicidal ideation through diminished meaning in life, B = 0.005, SE = 0.001, 95% CI [0.004, 0.007], and gratitude, B = 0.001, SE = 0.001, 95% CI [< 0.001, 0.002]. Gender differences were also observed. Although the results related to meaning in life appeared to replicate across gender, pathways involving gratitude differed among men and women. Overall, our findings suggest that helping veterans build meaning and appreciation in everyday life may be a proactive and holistic approach to suicide prevention.

Do childhood experiences influence associations between posttraumatic stress disorder symptoms and positive autobiographical memories among military veteran students? An exploratory study

BACKGROUND

Evidence links posttraumatic stress disorder (PTSD) symptoms and features of positive autobiographical memories (accessibility, vividness, coherence, sharing, emotional intensity, distancing). There is a knowledge gap on how adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) may influence these relationships.

OBJECTIVES

The current study explored whether the number ACEs or BCEs moderated associations between PTSD symptom severity and features of positive autobiographical memories.

DESIGN AND METHODS

The sample included 124 student military veterans who had experienced a trauma (Mage = 33.90; 77.4% male; 75.0% White).

RESULTS

Path analyses showed more PTSD symptom severity was significantly associated with less positive autobiographical memory vividness (β = -0.26, p = .019, R2 = 0.06). Further, the number of ACEs moderated the relationship between PTSD symptom severity and positive autobiographical memory accessibility (β = -0.25, p = .023, R2 = 0.10) and vividness (β = -0.20, p = .024, R2 = 0.10). Among individuals with more ACEs (1 SD above the mean) compared to those with fewer ACEs (1 SD below the mean), less accessibility and vividness of positive autobiographical memories was associated with greater PTSD symptom severity. The number of BCEs was not a significant moderator.

CONCLUSIONS

Positive memory-based interventions may be particularly useful to address PTSD symptoms among military veterans with a history of childhood adversity.

Daily-level associations between posttraumatic stress disorder symptoms and reactions to retrieving positive autobiographical memories

Trauma survivors with posttraumatic stress disorder (PTSD) report difficulties accessing and describing positive memories. To understand these patterns, we examined daily-level relations of PTSD symptoms with affective, cognitive (dwelling/rumination; pushing memory out of one's mind; suppression; avoidance; distraction; thinking about something else; remembering negative or positive memories/events; negative or positive thoughts; accepting or disapproving memory; reinterpreting memory), and behavioral (using alcohol/drugs; smoking cigarettes; cravings for or seeking out cigarettes/alcohol/drugs; craving, seeking out, or consuming large amounts of food; dissociation; engaging in risky behaviors; sharing memories; interference with ongoing task; arousal) reactions to retrieving positive memories. Eighty-eight trauma survivors (Mage= 39.89 years; 59.1% female) completed 7 daily measures of PTSD and reactions to retrieving positive memories. Days with more PTSD severity were associated with higher odds of same-day suppression, avoidance, distraction, thinking about something else, smoking cigarettes, craving substances, craving, seeking out, or consuming large amounts of food, dissociation, remembering negative memories/events/thoughts, engaging in risky behaviors, interference with ongoing tasks, and arousal (ORs=1.10-1.22); and greater negative affect (β = 0.27). Supplemental lagged analyses indicated some associations between previous-day reactions to positive memory retrieval and next-day PTSD severity and vice versa. Trauma survivors with PTSD symptoms report negative and avoidance-oriented reactions to retrieving positive memories.

Open Label Pilot Study on Posttrauma Health Impacts of the Processing of Positive Memories Technique (PPMT)

Processing of Positive Memories Technique (PPMT) was proposed as a novel intervention for posttraumatic stress disorder (PTSD). PPMT comprises of 5 sessions focused on identifying and processing positive memories. As an open label pilot study, we explored PPMT's effects on PTSD severity, depression severity, affect and cognitive processes, and therapeutic alliance. A sample of 12 trauma-exposed participants seeking services at a University Psychology Clinic participated in 5 PPMT sessions (Mage=29.25 years; 58.30% women). We used the reliable change indices and clinically significant change score approach. The following number of participants showed statistically reliable changes: 9 participants for PTSD severity (8 recovered/improved); 6 participants for depression severity (5 improved); 5 participants for positive affect levels (2 recovered/improved); 9 participants for negative affect levels (8 recovered); 9 participants for posttrauma cognitions (7 recovered/improved); 5 participants for positive emotion dysregulation (4 recovered); 11 participants for number of retrieved positive memories (3 recovered); and 5 participants for therapeutic alliance (4 recovered). PPMT may impact certain posttrauma targets more effectively (PTSD, depression, negative affect, posttrauma cognitions). PPMT may be more helpful in improving regulation rather than levels of positive affect. PPMT, if supported in further investigations, may add to the clinician tool-box of PTSD interventions.

Relations Between Posttraumatic Stress Disorder Symptoms and Positive Memory Characteristics Among Women Reporting Intimate Partner Violence: A Micro-Longitudinal Study

Evidence links posttraumatic stress disorder (PTSD) symptoms to positive autobiographical memory characteristics. To extend this research, we uniquely utilized micro-longitudinal data to examine (1) the trajectory of PTSD symptom count across 30 days; and (2) if more vividness and accessibility of retrieved positive memories at the daily level predicted decreases in the trajectory of PTSD symptom count across 30 days. The current study was a secondary data analysis of a larger study. The sample included 74 women who reported physical or sexual victimization in the past 30 days by their current male partner and reported the use of alcohol and/or drugs during that time (M_age = 39.68 years; 37.80% with diagnostic PTSD; 43.2% White; 37.8% Black or African American). They completed thrice daily measures of PTSD symptoms and positive memory characteristics (vividness and accessibility) across 30 days. Results of the random effects longitudinal multilevel model indicated that, on average, the relation between PTSD symptom count and positive memory vividness was positive and statistically significant (0.19, 95% Confidence Interval [CI] [0.2, 0.35]); and the relation between PTSD symptom count and positive memory accessibility was positive and statistically significant (0.31, 95% CI [0.15, 0.47]). The relationship between PTSD symptom count and positive memory vividness/accessibility (i.e., slopes) varied significantly across participants, with a wide range of positive and negative regression coefficients. Future research needs to investigate why and how positive memory vividness and accessibility may relate to trajectories of PTSD symptoms over time, with potential clinical implications for positive memory interventions addressing PTSD.

Do positive memory characteristics influence daily-level trajectories of posttraumatic stress disorder symptoms? an exploratory daily diary study

BACKGROUND AND OBJECTIVES

Evidence links posttraumatic stress disorder (PTSD) with positive memory characteristics. To extend this research, we utilized daily diary data to examine (1) concurrent/lagged associations between daily PTSD symptom severity and positive memory vividness/accessibility; and (2) associations between baseline-assessed positive memory characteristics and changes in PTSD symptom severity over time.

DESIGN AND METHODS

A sample of 238 trauma-exposed participants (Mage = 21.19 years; 86% women) completed baseline and 10 daily measures of PTSD symptoms and positive memory characteristics. Multilevel models covaried for gender, number of trauma types, and number of completed surveys.

RESULTS

Days with greater PTSD symptom severity than an individual's average associated with less vividness (b = -0.02, p < .001) and accessibility (b = -0.02, p < .001) of the positive memory on the same day. Days with greater positive memory vividness (b = -1.06, p < .001) and accessibility (b = -0.93, p < .001) than an individual's average associated with less PTSD symptom severity on the same day. There were no significant lagged associations between these constructs. There were significant interactions between baseline-assessed psychological distance and time (b = -0.04, p  = .042) and between baseline-assessed visual perspective and time (b = 0.05, p = .023) on PTSD symptom severity across days.

CONCLUSIONS

Findings inform positive memory intervention targets for PTSD and provide impetus for longitudinal investigations on their inter-relations.

Associations between positive memory count and hazardous substance use in a trauma-exposed sample: Examining the moderating role of emotion dysregulation

OBJECTIVES

Research has demonstrated links between autobiographical memory retrieval and hazardous substance use. However, limited work has examined relations between positive autobiographical memories and hazardous substance use, as well as moderating factors influencing these relations. Thus, we examined the potential moderating roles of negative and positive emotion dysregulation in the relations between count of retrieved positive memories and hazardous substance use (alcohol and drug use separately).

METHODS

Participants were 333 trauma-exposed students (Mage  = 21.05; 85.9% women) who completed self-report measures assessing positive memory count, hazardous alcohol and drug use, negative emotion dysregulation, and positive emotion dysregulation.

RESULTS

Positive emotion dysregulation significantly moderated the association between positive memory count and hazardous alcohol use (b = 0.04, 95% confidence interval [CI] [0.01, 0.06], p = 0.019), as well as the association between positive memory count and hazardous drug use (b = 0.02, 95% CI [0.01, 0.03], p = 0.002). Individuals with more positive emotion dysregulation had stronger associations between increases in positive memory count and increased hazardous substance use.

CONCLUSION

Findings indicate that trauma-exposed individuals who retrieve more positive memories and experience difficulties regulating positive emotions report greater hazardous substance use. Positive emotion dysregulation may be an important target for memory-based interventions among trauma-exposed individuals who report hazardous substance use.

Processing of Positive Memories Technique: Feedback From Trauma-Exposed Clients on Processing of Positive Memories Technique Components, Format, and Feasibility

ABSTRACT

Although the majority of research and clinical interventions focused on posttraumatic stress disorder (PTSD) centers on traumatic memories, recent literature suggests the importance of considering emotionally laden memories more broadly among trauma-exposed individuals. Specifically, trauma-exposed individuals have difficulties retrieving positive and negative memories, and interventions focused on enhancing the retrieval of both traumatic and positive memories benefit overall well-being. These findings led to the development of a novel Processing of Positive Memories Technique (PPMT) for PTSD. As the next step in treatment development, PPMT was piloted among 12 trauma-exposed community members seeking therapeutic or assessment services at a university psychology clinic. In this study, we summarize participants' quantitative and qualitative feedback on the content, format, and feasibility of PPMT. Next, we outline proposed formative changes that are critical to the iterative refinement of PPMT, based on the obtained feedback to enhance its scalability, feasibility, and effectiveness. Within clinical practice, PPMT, as implemented in this study, may be feasible, and there may be potential benefits to incorporating positive memory processing using PPMT.

The Role of Emotion Dysregulation in the Relationship Between Sleep Disturbances and PTSD Symptom Severity

ABSTRACT

Emotion dysregulation is implicated in the development, maintenance, and treatment of sleep disturbances and posttraumatic stress disorder (PTSD) separately. However, few studies have assessed interactions among these variables. To address this gap, this study examined whether the associations of sleep quality and sleep quantity with PTSD severity were stronger at higher levels of negative and positive emotion dysregulation in a community sample of 199 trauma-exposed individuals. This study found that both poorer sleep quality and lower sleep quantity were associated with greater PTSD severity at low to average (but not high) levels of negative emotion dysregulation. Positive emotion dysregulation did not moderate the relationships between sleep quality or quantity and PTSD severity. Exploratory additive multiple moderation analyses showed significant associations between poorer sleep quality and lower sleep quantity with greater PTSD severity at low to average levels of negative emotion dysregulation, coupled with any level of positive emotion dysregulation. Findings inform theoretical perspectives on the sleep-PTSD relationship and clinical applications of targeting emotion dysregulation in the treatment of sleep disturbances and PTSD symptoms for trauma-exposed individuals.

Positive Affect Processes and Posttraumatic Stress Disorder Symptoms: Findings from an Open Label and Uncontrolled Pilot Study using the Positive Memory Processing Technique

Recently, a five-session Processing of Positive Memories Technique (PPMT) was proposed as a novel intervention for posttraumatic stress disorder (PTSD). One purported outcome of and mechanism underlying PPMT's effects on PTSD is improved positive affect processes. In this uncontrolled pilot study, we examined whether PPMT was associated with decreases in PTSD severity; and whether changes in positive affect levels, reactivity, and dysregulation related to changes in PTSD severity across sessions. The sample included 16 trauma-exposed participants seeking services at a University Psychology Clinic (Mage=27.44 years; 68.80% women). Multilevel linear growth models examined the main effects of each positive affect variable and their interactions with time on PTSD severity. PTSD severity decreased across PPMT treatment in each model (bs=-0.43 to -0.33; d=-0.03; ps<.001-0.008). There was a main effect of positive emotion dysregulation (b=1.16, d=0.11; p=0.009), but not of positive affect levels (p=0.821) or reactivity (p=0.356) on PTSD severity. However, positive affect processes did not modify the trajectory of PTSD severity across treatment. Regarding PTSD symptom clusters, there was an interaction between positive affect levels and time on alterations in arousal and reactivity (AAR) cluster severity (b=-0.01, p=0.036); individuals with positive affect levels 1 SD above the mean (b=-0.18, p<0.01) and at the mean (b=-0.10, p=0.01) had greater decreases in AAR cluster severity across treatment compared to individuals with positive affect levels 1 SD below the mean (b=-0.02, p=0.710). Findings suggest that PPMT may relate to improved PTSD symptoms; and that positive affect levels/dysregulation may be worthwhile targets for future investigations.

The effect of anti-frustration ability on academic frustration among Chinese undergraduates: A moderated mediating model

Background

With the ongoing push to improve the quality of talent in all professions, academic pressure on undergraduates is gradually increasing, leading to students feeling increasingly frustrated by academic stressors. As it becomes more widespread, the resulting issue of academic frustration is attracting public attention.

Aim

The current study explored the relationship between undergraduate anti-frustration ability (AFA) on their academic frustration (AF), focusing specifically on the roles played by core competence (CC) and coping style (CS) in this relationship.

Methods

Our sample comprised 1,500 undergraduate students from universities in China. Data collection made use of the Ability to Anti-Frustration Ability Questionnaire, the Academic Frustration Questionnaire, the Core Competence Questionnaire, and the Simple Coping Style Questionnaire.

Results

The results showed that: (1) AFA negatively predicted the AF of undergraduates, with CC mediating this relationship and (2) CS had a moderating effect on the relationship between CC and AF. We concluded that students who employ positive CS may be more successful in alleviating their AF to a larger extent, with the mediation of CC.

Interpretation

The results revealed the mechanism of AFA on AF, which will help schools consider and guide students' skills and abilities, both academically and personally.

The Relationship between Positive Memory Phenomenology and Alcohol Use among Trauma-Exposed Individuals

BACKGROUND

Evidence links positive memory characteristics and hazardous alcohol use (HAU). Relevant to the current study, evidence also indicates that trauma-exposed individuals, especially those with posttraumatic stress disorder (PTSD) symptoms, report difficulties retrieving/accessing positive memories and report HAU.

OBJECTIVE

Considering this literature, we uniquely examined if and which positive memory characteristics were associated with HAU, and the potential mediating role of PTSD symptom severity in the examined relations.

METHODS

A sample of 126 trauma-exposed community participants seeking mental health treatment (Mage=34.97 years) completed measures of HAU (Alcohol Use Disorders Identification Test), positive memory characteristics (Memory Experiences Questionnaire-Short Form [MEQ-SF]), and PTSD severity (PTSD Checklist for DSM-5). We conducted 8 hierarchical multiple regressions; Step 1 examined effects of gender and Step 2 added a single MEQ-SF dimension (specificity, valence, emotional intensity, sensory details, vividness, accessibility, coherence, sharing).

RESULTS

In Steps 1 (β=.27) and 2 (βs from .27-.28), gender was associated with HAU. In Step 2, positive memory characteristics of specificity (β=.17), sensory details (β=.17), sharing (β=.23), and valence (β=-.19) were associated with greater HAU. PTSD severity mediated relations between sensory details (β=.09, p=.048), emotional intensity (β=.12, p=.011), and sharing (β=.09, p=.036), and the extent of HAU.

CONCLUSIONS AND IMPLICATIONS

Results that specificity, greater sharing, more sensory details, and higher negative valence of positive memories were associated with greater HAU offer potential points of intervention.

Moderating effects of sleep difficulties on relations between posttraumatic stress disorder symptoms and positive memory count

OBJECTIVES

Posttraumatic stress disorder (PTSD) severity relates to positive memory retrieval difficulties. One variable potentially influencing this relation is sleep difficulties. We examined moderating effects of sleep difficulties (duration and quality) on relations between PTSD severity and count of specific positive memories covarying for age, gender, and depression.

METHODS

Participants were an Amazon Mechanical Turk-recruited trauma-exposed community sample of 205 respondents (M age  = 35.44; 61.40% women).

RESULTS

Moderated regression analyses indicated significant interaction effects between sleep quality (b = 0.03; p = 0.036) and PTSD severity on specific positive memory count. Among individuals reporting better sleep quality, there were negative associations between PTSD severity and specific positive memory count (b = -0.04, SE = 0.02, p = 0.010). Similar results were obtained for PTSD's intrusion and arousal clusters.

CONCLUSION

Results support targeting sleep quality and PTSD severity to improve positive memory retrieval in PTSD and memory interventions, and the importance of considering sleep when examining links between PTSD and positive memory retrieval.

Critical considerations for the positive memory-posttraumatic stress disorder model

Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has predominantly focused on traumatic memories. Thus, Contractor and colleagues proposed a Positive Memory-PTSD model, which highlighted potential benefits associated with and mechanisms underlying positive memory retrieval/processing among individuals reporting PTSD symptoms. To enhance research on and clinical impacts of this model, the current review provides critical considerations for the Positive Memory-PTSD model. Drawing from emerging research and clinical observations, we (i) clarify that the model addresses specific versus overgeneral positive memories; (ii) underscore the importance of considering the heterogeneity in, and transitionary nature of, affect processes following positive memory retrieval; and (iii) highlight the rationale for considering trauma type/count and co-occurring conditions, as potential moderators of relations between positive memory processing and PTSD. Hereby, we provide an updated Positive Memory-PTSD model and implications for positive memory interventions drawing from this model.