Examining Cultural Differences in the Associations between Appraisals and Emotion Regulation and PostTraumatic Stress Disorder in Malaysian and Australian Trauma Survivors

Self-construal modulates default mode network connectivity in refugees with PTSD

BACKGROUND

While self-construal and posttraumatic stress disorder (PTSD) are independently associated with altered self-referential processes and underlying default mode network (DMN) functioning, no study has examined how self-construal affects DMN connectivity in PTSD.

METHODS

A final sample of 93 refugee participants (48 with DSM-5 PTSD or sub-syndromal PTSD and 45 matched trauma-exposed controls) completed a 5-minute resting state fMRI scan to enable the observation of connectivity in the DMN and other core networks. A self-construal index was calculated by substracting scores on the collectivistic and individualistic sub-scales of the Self Construal Scale.

RESULTS

Independent components analysis identified 9 active networks-of-interest, and functional network connectivity was determined. A significant interaction effect between PTSD and self-construal index was observed in the anterior ventromedial DMN, with spatial maps localizing this to the left ventromedial prefrontal cortex (vmPFC), extending to the ventral anterior cingulate cortex. This effect revealed that connectivity in the vMPFC showed greater reductions in those with PTSD with higher levels of collectivistic self-construal.

LIMITATIONS

This is an observational study and causality cannot be assumed. The specialized sample of refugees means that the findings may not generalize to other trauma-exposed populations.

CONCLUSIONS

Such a finding indicates that self-construal may shape the core neural architecture of PTSD, given that functional disruptions to the vmPFC underpin the core mechanisms of extinction learning, emotion dysregulation and self-referential processing in PTSD. Results have important implications for understanding the universality of neural disturbances in PTSD, and suggest that self-construal could be an important consideration in the assessment and treatment of post-traumatic stress reactions.

Cultural differences in appraisals of control and posttraumatic stress disorder symptoms

Background: Appraisals are central to posttraumatic stress disorder (PTSD). Yet, few studies have examined how culture influences the associations between different types of trauma-related appraisals and PTSD symptoms.Objective: This study investigated cultural influences on appraisals of control and their associations with PTSD symptoms.Method: European Australian (n = 140, Mage = 35.80, SD = 12.44; 21 men, 97 women, 20 gender diverse/prefer not to report) and Chinese Australian (n = 129, Mage = 30.16, SD = 8.93, 21 men, 97 women, 20 gender diverse/prefer not to report) trauma survivors completed measures of appraisals, cultural values, and PTSD symptoms.Results: Findings showed that the Chinese Australian group was associated with greater Chinese cultural beliefs about adversity (i.e. emphasizing the value of adversity and people's ability to overcome adversity) and fewer fatalism appraisals (i.e. appraising one's destiny as externally determined), which in turn were atemporally associated with fewer PTSD symptoms; these atemporal indirect associations were moderated by self-construal and holistic thinking. The Chinese Australian group also reported fewer secondary control appraisals (i.e. attempts to change aspects of the self and accept current circumstances), which were atemporally associated with greater PTSD symptoms. In contrast, the European Australian group was associated with fewer primary control appraisals (i.e. perceived ability to personally change or control a situation), which were atemporally associated with greater PTSD symptoms.Conclusion: These findings highlight the importance of considering the influence of culture on appraisals in PTSD. However, it must be noted that causal relationships cannot be inferred from cross-sectional mediation analyses and thus, future longitudinal research is needed.

The Difficulties in Interpersonal Regulation of Emotions Scale (DIRE): Factor Structure and Measurement Invariance across Gender and Two Chinese Youth Samples

Effective interpersonal emotion regulation (IER) strategies have been found to be meaningful predictors for positive psychological functioning. The Difficulties in Interpersonal Regulation of Emotions Scale (DIRE) is a measure developed to assess maladaptive IER strategies. This study aimed to examine the psychometric properties of the Chinese version of DIRE using two college student samples (Sample 1: n = 296; Sample 2: n = 419). The two-factor structure of DIRE (venting and excessive reassurance-seeking) was confirmed through an exploratory structure equation modeling approach. Our results demonstrated that the Chinese version of DIRE exhibits a similar factor structure (in both samples) as the original DIRE. Measurement invariance across gender and samples was also achieved. Latent mean analyses demonstrated that females more frequently reported excessive reassurance-seeking (in both samples) and venting (in Sample 1) than males. Furthermore, venting and excessive reassurance-seeking were significantly related to intrapersonal emotion regulation and well-being indicators. Although in Chinese culture DIRE performs somewhat differently from the original DIRE, the current findings suggest that DIRE is a reliable and valid scale with which to measure the IER strategies in Chinese culture and the use of this measure in clinical practice may allow for an accurate assessment of emotion regulation deficits in clients from other diverse cultures.

Examining the associations between control (primary and secondary) appraisals and posttraumatic stress disorder symptoms in Malaysian and Australian trauma survivors

Background

Little research has considered the influence of culture on control appraisals in the context of posttraumatic stress disorder (PTSD).

Objectives

This study aimed to investigate whether cultural group moderated the relationship between control (primary and secondary) appraisals and PTSD symptoms in trauma survivors from Western (Australian) and Asian (Malaysian) cultural contexts.

Methods

Trauma survivors (107 Australian with European cultural heritage; 121 Malaysian with Malay, Indian or Chinese cultural heritage) completed an online survey assessing PTSD symptoms and appraisals of control.

Results

Cultural group moderated the association between primary control and PTSD symptoms; the positive association was significant for the Australian group but not the Malaysian group. While cultural group did not moderate the association between secondary control and PTSD symptoms, there was an indirect pathway between secondary control appraisals and PTSD symptoms through interdependent self-construal for both cultural groups.

Conclusion

The findings indicate that cultural group and self-construal influence the associations between different types of control appraisals and PTSD. Further research exploring the role of culture and different appraisal types in PTSD is needed.

Psychometric properties of the Malay version of the difficulties in Emotion Regulation Scale-18 in Malaysian adolescents

OBJECTIVE

The Difficulties in Emotion Regulation Scale-18 (DERS-18) is an instrument used to measure deficits in emotion regulation. However, the instrument has not been adapted to Malaysians and has never been validated in the Malay language. This study aimed to examine the psychometric properties of the Malay version of DERS-18.

METHOD

The DERS-18 underwent forward-backward translation and assessment of face and content validity. Both Malay version of the DERS-18 and DASS-21 were completed by 701 adolescents (44.4% boys) aged 13 and 14 years old. To assess its dependability, a floor and ceiling effect evaluation and Cronbach's analysis were both performed. A series of confirmatory factor analyses (CFA), bivariate correlation, and regression were performed to evaluate the construct and criterion validity, respectively.

RESULTS

The Malay version of DERS-18, after excluding "Awareness", indicated excellent reliability (Cronbach's α = 0.93), and acceptable internal consistency for each subscale (range of α from 0.63 to 0.82). Floor or ceiling effects were observed at item level and subscale level, but not at total level. CFA results revealed that the Malay version of the DERS-18 bifactor model (excluding "Awareness") portrayed the best construct validity (χ2/df = 2.673, RMSEA = 0.049, CFI = 0.977, TLI = 0.968) compared to a single factor, a correlated factor, and a higher-order factor model. The DERS-18 subscales (except "Awareness") and DERS-18 total scores were significantly correlated with stress, anxiety, and depression in a positive direction (r ranged from 0.62 to 0.64, p < 0.01). The general factor of the DERS-18 and its specific factors ("Clarity", "Goals", and "Non-Acceptance") significantly predicted the symptoms of stress, anxiety, and depression (R2 ranged from 0.44 to 0.46, p < 0.001).

CONCLUSION

The Malay version of the DERS-18, excluding "Awareness", possessed good reliability, construct validity, and criterion validity to assess emotion dysregulation among Malaysian adolescents.

Investigating the associations between cognitive appraisals, emotion regulation and symptoms of posttraumatic stress disorder among Asian American and European American trauma survivors

This study investigated whether the associations between emotion regulation and cognitive appraisals and symptoms of posttraumatic stress disorder (PTSD) differ between Asian American and European American trauma survivors. Asian American (n = 103) and European American (n = 104) trauma survivors were recruited through mTurk and completed an on-line questionnaire assessing cognitive appraisals, emotion regulation and PTSD symptomatology. The European American group reported greater trauma-specific rumination, psychological inflexibility, seeking out others for comfort, and negative self-appraisals than the Asian American group. The Asian American group reported greater secondary control appraisals and cultural beliefs about adversity than the European American group. Second, cultural group moderated the associations between (a) brooding rumination, (b) fatalism, (c) self-blame, and (d) negative communal self-appraisals and PTSD symptoms. These associations were larger for the European American group than the Asian American group. Third, there was an indirect pathway from self-construal (independent and interdependent) to PTSD symptoms through certain emotion regulation approaches and cognitive appraisals. Additionally, cultural group was found to moderate several of these indirect effects. These findings highlight the importance of considering cultural background and cultural values in understanding the processes involved in PTSD. Further research in this area is needed.

Translation and Validation of the Malay Version of the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA)

The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) has been translated and adapted globally. This study aimed to examine the psychometric properties of the Malay version of the ERQ-CA. The ERQ-CA underwent forward and back translation twice and was tested in two separate studies, Study 1 and Study 2, with 296 and 359 students aged between 13 and 14 years old, respectively. Cronbach's alpha values were calculated, and confirmatory factor analysis was conducted. The results from Study 1 demonstrate good internal consistency for cognitive reappraisal and expressive suppression. The results indicate a good factor loading for most of the items, but only one value of the goodness-of-fit met the criteria for a good fit. The results from Study 2 show improvements in the values of the goodness-of-fit that are comparable to previous studies, but there was a decrease in the factor loading scores. Overall, the Malay version of the ERQ-CA possesses acceptable reliability and validity. Further studies are required in the near future to develop a Malay version of the ERQ-CA that reasonably represents Malaysian adolescents.