Cross-lagged analyses of anger and PTSD symptoms among veterans in treatment.

Abstract

Objective: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. Method: Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month followup. Bidirectional influences were assessed using cross-lagged panel analyses. Results: The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. Conclusions: Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD. Clinical Impact StatementThe findings of this study indicate that significant anger problems are common issues among Australian current and ex-serving military members who seek treatment for posttraumatic stress disorder (PTSD). Furthermore, anger can influence change in PTSD symptoms, and particularly avoidance symptoms, across both treatment and posttreatment follow-up. This suggests that anger is clinically important and may undermine the extent and maintenance of benefits of routine PTSD treatments. Treatment services and providers should consider routinely assessing and addressing anger in the context of treatment for military-related PTSD.

Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD

“…Furthermore, studies have also found that changes in specific trauma appraisals are associated with or even predict changes in PTSD (e.g. Cowlishaw et al, 2022 ; Foa & Rauch, 2004 ; Ginzburg et al, 2009 ; Görg et al, 2017 ) in different trauma samples receiving trauma-focused treatment.…”

Association between different dimensions of anger and symptoms of post-traumatic stress disorder in at-risk cardiovascular patients during the COVID-19 pandemic

“…On the other hand, a benefit of anger interventions was found in subjects with anger problems. You can therefore also benefit from such interventions before starting trauma-specific therapy ( 60 ) because anger has been shown to be a relevant factor in PTSD therapy ( 61 ).…”

A daily diary study of the romantic partner relationship dynamics associated with anger and other posttraumatic stress disorder symptoms

“…This is consistent with findings that anger is highly correlated with other PTSD symptoms and accounts for a substantial proportion of the variance in total PTSD symptom severity (Durham et al., 2018). In addition, anger appears to exacerbate reexperiencing, avoidance, and hyperarousal symptoms of PTSD over a period of months (Cowlishaw et al., 2022), whereas there is evidence for effects in the opposite direction when measured over a period of hours (Van Voorhees et al., 2018). Importantly, anger has also been shown to mediate the longitudinal association between PTSD symptoms and suicidal ideation in military veterans (Dillon et al., 2020), potentially via consequences of anger, such as interpersonal conflict and reduced social support (Diong et al., 2005).…”