Emotional Clarity, Anxiety Sensitivity, and PTSD Symptoms Among Trauma-Exposed Inpatient Adolescents

Abstract

Although several investigations-on primarily adult samples-demonstrate a potential role of emotion dysregulation in the etiology and maintenance of posttraumatic stress disorder (PTSD), investigations into the mechanisms that may underlie these associations in general and among adolescents in particular are lacking. The present study examined associations among emotional clarity (i.e., the extent to which individuals are confused about the specific emotions they are experiencing), (Gratz, Journal of Psychopathology Behavioral Assessment 26(1):41-54, 2004) anxiety sensitivity, and DSM-IV PTSD symptom cluster severity (i.e., re-experiencing, avoidance, and hyperarousal symptoms) in a diverse sample of trauma-exposed inpatient adolescents. It was hypothesized that anxiety sensitivity would underlie association between emotional clarity and PTSD symptoms. Participants (N = 50; 52.0% female; M = 15.1 years, SD = 0.51; 44% White) completed measures of emotion dysregulation, anxiety sensitivity, and PTSD. Lower emotional clarity was significantly associated with greater total PTSD symptoms, as well as re-experiencing, avoidance, and arousal symptoms. Additionally, there were indirect effects for lack of emotional clarity via anxiety sensitivity in relation to total PTSD symptoms [B = 0.17, SE = 0.08, BC 95% CI (0.04, 0.35)], re-experiencing symptoms [B = 0.15, SE = 0.08, BC 95% CI (0.03, 0.36)], avoidance symptoms [B = 0.12, SE = 0.07, BC 95% CI (0.02, 0.29)], and hyperarousal symptoms [B = 0.17, SE = 0.08, BC 95% CI (0.04, 0.36)]. Reversed models were violated, supporting the direction of hypothesized effects. Difficulties recognizing and accurately understanding emotions may increase risk for PTSD symptoms among trauma-exposed youth. Furthermore, anxiety sensitivity may be a promising intervention target among youth at risk for PTSD, especially among those demonstrating poorer emotional clarity.

Emotion dysregulation as a maintenance factor for posttraumatic stress symptoms: The role of anxiety sensitivity

“…In line with our hypothesis, we found that elevated emotion dysregulation at baseline predicted increases in PTSS at Month‐1 follow‐up through heightened AS at Week 3, after controlling for treatment condition and initial PTSS and AS. These findings are consistent with limited cross‐sectional work examining the mechanistic role of AS as it relates to emotion dysregulation and PTSS (Viana et al, 2018; Viana et al, 2017; Woodward et al, 2018), and expands this work by utilizing a diverse clinical sample of adults. Theory suggests that emotion dysregulation may entail greater difficulties discerning between bodily sensations and negative emotional states, leading individuals to view bodily sensations as unpredictable and frightening (Tull, 2006).…”

“…Difficulties engaging in goal‐oriented behaviors when distressed may restrict exposure to situations involving high anxious arousal; in turn, individuals may not learn corrective information about internal sensations that may accompany PTSD hyperarousal (Tull & Gratz, 2008). While our results are the first to demonstrate the significance of this subscale within the proposed mediational model, these findings are inconsistent with recent cross‐sectional work highlighting the roles of emotional clarity and nonacceptance (Viana et al, 2018; Viana et al, 2017). It may be that global emotion dysregulation exhibits a larger effect size and may be most useful to consider for predicting PTSS through AS.…”

“…Intervention effects from the larger clinical trial are reported elsewhere (Allan, Boffa, Raines, & Schmidt, 2018; Short et al, 2017). Specifically, based on prior work among adolescents (Viana et al, 2018), we hypothesized that elevated emotion dysregulation at baseline would predict greater Month‐1 PTSS severity through Week‐3 AS, after controlling for condition and baseline levels of PTSS and AS. To further test the specificity of AS, we explored two additional cognitive‐affective factors related to PTSS as alternate mediators in the proposed model.…”

The Mediating Role of Catastrophizing in the Relationship Between Emotional Clarity and Posttraumatic Stress Symptoms Among Earthquake Survivors in Korea: A Cross-Sectional Study

“…Many studies have empirically demonstrated that difficulties in each stage of the emotion regulation process following traumatic events may contribute to the development of PTSD. For example, when emotional clarity is low, the negative impact of traumatic events was significantly greater (Shipman et al, 2005;Viana et al, 2018). Another study showed that implementing maladaptive emotion regulation strategies (e.g., emotional avoidance) as a response to emotional difficulties can lead to PTSD (Tull et al, 2011).…”

Acute Restraint Stress Evokes Anxiety-Like Behavior Mediated by Telencephalic Inactivation and GabAergic Dysfunction in Zebrafish Brains

“…Anxiety is a very common behavioral disorder associated with a traumatic experience in humans [1][2][3][4] . The use of animal models to describe brain disorders related with traumatic events represents an important tool for development of new treatments and drug discoveries.…”