Emotion and PTSD

Today, we’re looking at two studies of emotion processing in PTSD. First, Zhan, Zhang, Gong & Geng (2023) published “Clinical Correlates of Irritability, Anger, Hostility, and Aggression in Posttraumatic Stress Disorder” in Psychological Trauma: Theory, Research, Practice, and Policy.  

The edited abstract and impact statement are as follows:

Although irritability, anger, and aggression are diagnostic symptoms of posttraumatic stress disorder (PTSD), their clinical significance and associations with psychopathology remain unclear. In a sample of community adults with probable PTSD (n = 151), we measured irritability, physical aggression, verbal aggression, anger, and hostility with the Brief Irritability Test and the Brief Aggression Questionnaire. Participants’ psychopathology, including depression, attention deficit and hyperactivity disorder (ADHD), psychotic-like experiences, insomnia, as well as suicidal behaviors were also assessed. Correlation analysis showed that irritability and anger were modestly related to all PTSD dimensions; physical aggression was related to avoidance, negative alterations in cognitions and mood (NACM), and hyperarousal; hostility was related to reexperiencing, NACM, and hyperarousal; while verbal aggression was not significantly related to any PTSD dimensions. After adjustment for trauma exposure and PTSD symptoms, irritability was associated with almost all psychopathology and suicidal behaviors, however, anger, hostility, and aggression were sparsely related to some psychopathology or suicidal behaviors. Particularly, anger was only related to ADHD and insomnia. Latent profile analysis based on PTSD, irritability, anger, hostility, and aggression indicated two discrete subgroups: the high severity group (33.8%) and the low severity group (66.2%), with high severity group reporting higher rates of comorbidity and suicidal behaviors. The findings support irritability, aggression, anger, and hostility as separate constructs; moreover, irritability, anger, and aggression should be independently measured in PTSD. 

Irritability, anger, hostility, and aggression are highly related but distinct constructs, which should be assessed independently by well-validated instruments in trauma-exposed populations. Irritability might be added into posttraumatic stress disorder (PTSD) dimensions, given that it is one important indicator for comorbidity of PTSD and risk of suicide. There might be one subgroup of PTSD characterized by high severity of irritability, anger, and aggression. The findings highlight the understanding of psychopathological mechanisms of irritability, anger, and aggression in PTSD, and targeted interventions for irritability, anger, or aggression in PTSD treatment. 

I like this study because it emphasizes the intense emotions individuals with PTSD may well experience. The next study suggests that intensity of feelings may be a predictor of faster recovery. Graziano, LoSavio, White, Beckham & Dillon (2023) published “Examination of PTSD Symptom Networks over the Course of Cognitive Processing Therapy” in Psychological Trauma: Theory, Research, Practice, and Policy. The edited abstract and impact statement report:

Cognitive processing therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD); however, little is known about how interrelationships between PTSD symptoms change over the course of treatment. The current study examined baseline, midtreatment, and posttreatment PTSD symptom networks during CPT for PTSD. Adults with PTSD (n = 107) received 12 sessions of CPT as part of a randomized trial. Self-reported PTSD symptoms were assessed at pretreatment, midtreatment, and posttreatment, and network analysis was used to examine the interrelationships between symptoms at these three timepoints. Linear regression was conducted to examine whether any baseline symptoms or midpoint symptoms predicted overall treatment change. In the baseline PTSD network, feelings of detachment and feeling upset at reminders of the trauma were central to the symptom network. These symptoms were no longer central at midtreatment, possibly suggesting that CPT quickly reduces the importance of these symptoms. These findings were consistent with regression results that, after accounting for multiple comparisons, high baseline scores of feeling upset at trauma reminders predicted later treatment change. At the conclusion of treatment, strong negative emotions were the most central symptom and may be most important in maintaining or lowering other PTSD symptoms at the conclusion of treatment. Before treatment, detachment and feeling upset from reminders of the trauma were found to be important in maintaining the other PTSD symptoms, but over the course of treatment this did not persist. In fact, individuals with high levels of feeling upset from reminders of the trauma experienced the greatest reductions in PTSD symptoms. 

The findings from both of these studies may be helpful to clinicians and therapists who work with clients presenting PTSD symptoms. They may also help guide recommendations for support and treatment.