A systematic review of the psychosocial impact of emotional numbing in US combat veterans

Schuman, Donna L.; Bricout, John C.; Peterson, Heather; Barnhart, Sheila

doi:10.1002/jclp.22732

Cited by 11 publications

(9 citation statements)

References 65 publications

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“…While simultaneously accounting for prior psychosocial functioning, demographic characteristics, depressive symptoms, alcohol use, and cumulative trauma exposure, PTSD‐related anhedonia was the only statistically significant PTSD factor in its prediction of impairment in later psychosocial functioning above and beyond the contributions of other PTSD symptom clusters. In general, these findings both support and extend conclusions from prior research (Schuman et al., 2019 ). However, this study expanded upon prior research by addressing important limitations, such as using updated DSM‐5 diagnostic criteria, isolating specific anhedonia symptoms, employing a longitudinal design, and controlling for important covariates (e.g., depressive symptoms).…”

Section: Discussionsupporting

confidence: 90%

“…Posttraumatic stress disorder (PTSD) affects approximately 8% of all United States veterans (Wisco et al., 2016 ) and is associated with substantial psychiatric comorbidity (Fairbank et al., 2001 ) and suicidality (Schuman et al., 2019 ). As currently constituted in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders ( DSM‐5 ; American Psychiatric Association [APA], 2013 ), PTSD is characterized by 20 symptoms parceled into several symptom clusters.…”

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confidence: 99%

“…Prior research has investigated the associations between PTSD symptom clusters and specific outcomes of interest, such as psychosocial functioning. A systematic review of the findings from 24 studies on the association between PTSD symptom clusters and functional impairment among U.S. combat veterans (Schuman et al., 2019 ) revealed that symptoms depicting emotional numbing were more strongly related to impairment in psychosocial functioning compared to other PTSD symptoms (e.g., intrusions, avoidance). Emotional numbing and anhedonia are terms often used to reflect dampened appetitive functioning (Kashdan et al., 2006 ; Pizzagalli, 2014).…”

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confidence: 99%

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Posttraumatic stress disorder–related anhedonia as a predictor of psychosocial functional impairment among United States veterans

May

Wisco

Fox

et al. 2022

Journal of Traumatic Stress

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Prior research suggests that anhedonia symptoms related to posttraumatic stress disorder (PTSD; i.e., diminished interest, detachment from others, and difficulty experiencing positive emotions) are consistently associated with a higher degree of impairment in psychosocial functioning beyond that associated with other PTSD symptoms. Unfortunately, much of this research has used cross‐sectional study designs; relied upon outdated DSM diagnostic criteria; and failed to control for potentially confounding variables, such as the presence of co‐occurring depression. This study used data from Waves 2 and 4 (n = 1,649) of the Veterans’ After‐Discharge Longitudinal Registry (Project VALOR), a longitudinal dataset of U.S. Army and Marine veterans. As measured using the Inventory of Psychosocial Functioning, Wave 4 psychosocial functioning was regressed on seven PTSD symptom factors at Wave 2 (i.e., intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal) and potential Wave 2 confounds. The Anhedonia factor, β = .123, most strongly predicted later psychosocial functional impairment beyond the impact of other PTSD symptom factors, βs = −.076–.046. Clinical implications of these findings are also discussed.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

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confidence: 99%

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Posttraumatic stress disorder–related anhedonia as a predictor of psychosocial functional impairment among United States veterans

May

Wisco

Fox

et al. 2022

Journal of Traumatic Stress

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“…In addition, there is evidence that responses to intrusions and intrusion‐related distress may intensify emotion dysregulation and associated problems, including impulsive and risky behavior. For example, emotional numbing has been associated with behavioral indicators of emotion dysregulation (Schuman et al., 2019), and higher levels of rumination have been linked to risky behavior among veterans with PTSD and depressive symptoms (Borders et al., 2012). The emotional regulatory role of such behavior is supported by multiple findings that suggest impulsivity and problem behavior function as maladaptive strategies for coping with trauma‐related distress (Kingston et al., 2010; Miles et al., 2016).…”

Section: Figurementioning

confidence: 99%

Cumulative Trauma Exposure and Chronic Homelessness Among Veterans: The Roles of Responses to Intrusions and Emotion Regulation

Macia

Moschetto

Wickham

et al. 2020

Journal of Traumatic Stress

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Veterans with mental health problems and a history of interpersonal and military trauma exposure are at increased risk for chronic homelessness. Although studies have examined posttraumatic stress disorder (PTSD) as a predictor of homelessness, there is limited understanding of specific mechanisms related to cumulative trauma exposure. We sought to elucidate how cumulative interpersonal and military trauma exposure may be linked to homelessness chronicity by examining the role of factors that influence trauma recovery and functional impairment. Specifically, we examined the indirect association of cumulative trauma exposure with homelessness chronicity through distress and responses to trauma-related intrusions and emotion regulation problems in a sample of 239 veterans in community-based homeless programs. Participants completed measures of trauma exposure, responses to intrusions, intrusion distress, difficulties with emotion regulation, and duration and episodes of homelessness. Structural equation modeling was used to test a serial indirect effect model in which cumulative trauma exposure was indirectly associated with homelessness chronicity through distress from and responses to intrusions as well as emotion regulation problems. The results supported the hypothesized sequential indirect effect for episodes of homelessness, indirect effect odds ratio (IE ORs) = 1.12-1.13, but not for current episode duration, IE OR = 1.05. Overall, the present findings elucidate specific trauma-related factors that may be particularly relevant to episodic patterns of homelessness and interfere with efforts to remain housed. These findings represent an important step toward shaping policy and program development to better meet mental health care needs and improve housing outcomes among homeless veterans.

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“…This is in line with previous studies which found that depressive symptoms impair psychosocial functioning in general (Hirschfeld et al, 2000) and in patients with PTSD in particular (Nichter et al, 2019). In addition to that, the numbing symptoms seem to link PTSD and depression (Armour et al, 2012; Hurlocker et al, 2018) and to substantially contribute to psychosocial impairment in patients with PTSD (Kuhn et al, 2003; Maguen et al, 2009; Rona et al, 2009; Schuman et al, 2019; Shea et al, 2010). Our results underline the importance of assessing and monitoring comorbid depression and symptoms of emotional numbing.…”

Section: Discussionmentioning

confidence: 99%

Sparse models for predicting psychosocial impairments in patients with PTSD: An empirical Bayes approach.

Stuke¹,

Priebe²,

Weilnhammer³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Posttraumatic stress disorder (PTSD) is associated with psychosocial impairments, which represent a relevant focus for therapy. Previous results on the clinical predictors of these psychosocial impairments were inconsistent. The data analyzed in these contexts often suffer from a high number of correlated predictors and small sample sizes, entailing the risk of model overfitting. In Bayesian regression, the problem of overfitting can be mitigated by usage of specific zero-centered (regularizing) prior distributions. In this study, we used the 2 most common Bayesian regression models, the Bayesian Ridge and the Bayesian Lasso, to predict psychosocial impairments in 192 patients of a day clinic for the treatment of PTSD. Method: Predictions were based on specific dimensions of PTSD symptoms previously revealed by factor analyses, as well as posttraumatic cognitions, depressive symptoms, comorbid disorders, and demographics. The variance of the prior distribution was estimated through empirical Bayes (maximum marginal likelihood) and an approximation to the posterior distribution was obtained with stochastic variational inference and with a local approximation (Laplace approximation). Results: Severe psychosocial impairments were mainly related to depressive symptoms and symptoms from the amnesia and numbing dimension of PTSD, while gender, posttraumatic cognitions, and reexperience and avoidance symptoms had no impact. As expected, the model coefficients were shrunken to zero when regularizing prior distributions were used, particularly for the Bayesian Lasso. Conclusion: Depressive and numbing symptoms are the main clinical correlates of psychosocial impairments in patients with PTSD. Usage of Bayesian and regularized regression can contribute to the generalizability and interpretability of research results. Clinical Impact StatementPosttraumatic stress disorders are associated with psychosocial impairments that represent a relevant therapeutic focus. In a sample of 192 patients with PTSD in a psychotherapeutic day clinic, we used novel statistical methods (Bayesian regularized regression) to investigate which of the various symptoms of PTSD are particularly associated with psychosocial impairments. We have found that patients with severe depressive and numbing symptoms particularly struggle with disease-related impairments during everyday activities, while gender, posttraumatic cognitions, and reexperience and avoidance symptoms had no or very little impact on functioning.

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A systematic review of the psychosocial impact of emotional numbing in US combat veterans

Cited by 11 publications

References 65 publications

Posttraumatic stress disorder–related anhedonia as a predictor of psychosocial functional impairment among United States veterans

Posttraumatic stress disorder–related anhedonia as a predictor of psychosocial functional impairment among United States veterans

Cumulative Trauma Exposure and Chronic Homelessness Among Veterans: The Roles of Responses to Intrusions and Emotion Regulation

Sparse models for predicting psychosocial impairments in patients with PTSD: An empirical Bayes approach.

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