Associations Between Difficulties in Emotion Regulation and Post-Traumatic Stress Disorder in Deployed Service Members of the German Armed Forces

Abstract

Background Experiencing a traumatic event can lead to post-traumatic stress disorder (PTSD), but not every traumatized person develops PTSD. Several protective and risk factors have been identified in civilians and veterans to explain why some individuals develop PTSD and others do not. However, no research has confirmed the relationship between emotion regulation and PTSD in deployed German Armed Forces service members after a foreign assignment. Previous studies have identified some protective factors, such as social support, social acknowledgment, specific personal values, and posttraumatic growth, as well as risk factors, like moral injury and emotion regulation. Thus, the aim of the present study is to confirm the relationship between emotion regulation and PTSD and to test for factors that are associated with higher severity of PTSD symptoms in such a sample. Methods A post-hoc secondary analysis was conducted on data collected in a randomized controlled trial. Participants ( N = 72) were male active and former military service members that have returned from deployment and were recruited from the German Armed Forces. These participants were separated into two groups according to PTSD diagnosis based on the results of a structured diagnostic interview. Data from evaluation questionnaires administered upon entry into the study were subjected to a cross-sectional analysis. The measures included the severity of PTSD symptoms, clusters of PTSD symptoms, clinical measures, and several measures assessing PTSD-related constructs. Analyses included the Spearman rank correlation coefficient, X 2 tests for nominal data, Mann-Whitney U-tests for non-parametric data, and a mediation analysis. Results The results of the mediation analysis revealed that difficulties in emotion regulation were significantly associated with the severity of PTSD symptoms, which was mediated by social acknowledgment and experimental avoidance but not by moral injury. The analyses showed that the severity of PTSD symptoms and all clusters of PTSD symptoms were significantly associated with most of the measured constructs in expectable directions. Participants in the PTSD group showed significantly higher mean scores on questionnaires measuring constructs that have been associated with PTSD, like emotion regulation and moral injury. They also showed lower mean scores in questionnaires for social support and social acknowledgment as a victim or survivor than participants in the non-PTSD group. Conclusion The present results show that difficulties in emotion regulation are directly associated with the severity of PTSD symptoms in service members of the German Armed Forces. This association is mediated by social acknowledgment and experimental avoidance, but not by moral injury. Thus, future studies should investigate these potentially crucial factors for better u...

Decreased Emotional Dysregulation Following Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy (3MDR): Identifying Possible Driving Factors in Remediation of Treatment-Resistant PTSD

“…Associated with reduced ER [5,19,20], symptoms of PTSD include negative mood, cognitive deficits, avoidance, and hyperarousal (PTSD diagnostic criteria D, C, and E, respectively). Recent studies suggest that difficulties with ER may exacerbate severity and maintain PTSD symptoms [19,20].…”

Decreased Emotional Dysregulation Following Multi-modal Motion-assisted Memory Desensitization and Reprocessing Therapy (3MDR): Identifying Driving Factors in Remediation of Treatment-Resistant PTSD

“…Associated with reduced ER (Bryant, 2019;Raudales et al, 2020;Spies et al, 2020), symptoms of PTSD include negative mood, cognitive deficits, avoidance, and hyperarousal (PTSD diagnostic Criterions D, C and E respectively). Recent studies suggest that difficulties with ER may exacerbate severity and maintain PTSD symptoms (Raudales et al, 2020;Spies et al, 2020).…”

“…Associated with reduced ER (Bryant, 2019;Raudales et al, 2020;Spies et al, 2020), symptoms of PTSD include negative mood, cognitive deficits, avoidance, and hyperarousal (PTSD diagnostic Criterions D, C and E respectively). Recent studies suggest that difficulties with ER may exacerbate severity and maintain PTSD symptoms (Raudales et al, 2020;Spies et al, 2020). In particular, aspects of ED such as maladaptive or absent regulatory strategies, avoidance and repression of emotions, and or unawareness of emotions have been linked to PTSD symptom severity (Christ et al, 2021).…”

“…Underlying the efficacy of the 3MDR intervention in regulating ED may be the combination of treatment methods (treadmill walking, EMDR, and exposure therapy). Difficulties with ER are highly correlated with severity and maintenance of TR-PTSD (Raudales et al, 2020;Spies et al, 2020). 3MDR may facilitate ER in that, layer by layer, dysregulated emotions ranging from intense sadness, grief, loss, or anger, shame, betrayal or guilt, are addressed in the course of treatment.…”

“…Protopopescu et al (2020) suggest that MI severity is positively correlated with severity of cluster C and D PTSD symptoms (avoidance and negative alterations in cognition and mood; APA, 2013). Although MI is associated with PTSD, it differs in neuropathology (Spies et al, 2020), and therefore may require alternative treatment approaches. Therefore, addressing ER may be effective in treating MI in addition to PTSD, and may explain 3MDR's efficacy over other conventional therapeutic approaches.…”