Positive and negative affect in the daily life of world trade center responders with PTSD: An ecological momentary assessment study.

Abstract

The ability to experience positive affect (PA) has clinical and quality of life implications, particularly in vulnerable populations such as trauma-exposed disaster responders. Low PA is included in the diagnostic criteria for posttraumatic stress disorder (PTSD), however evidence for PA reduction in PTSD has been mixed. In contrast, negative affect (NA) has consistently been found to be elevated among individuals with PTSD. Multiday, ecological momentary assessment (EMA) can provide more ecologically valid evidence about experiences of affect; however, no such studies have been conducted in traumatized individuals with PTSD to date. Method: World Trade Center (WTC) responders (N ϭ 202) oversampled for the presence of PTSD were recruited from the WTC Health Program. Participants were administrated the Structured Clinical Interview for DSM-IV and the PTSD Checklist for DSM-5 at baseline, then completed EMA surveys of affect four times a day over seven consecutive days. Results: Participants with current PTSD (19.3% of the sample) showed significantly higher levels of daily NA compared with those without PTSD. However, there was no group difference in daily PA, nor was PA associated with a dimensional measure of PTSD. Conclusion: Results suggest that for chronic PTSD among disaster responders, positive emotions are not inhibited across daily living. Such findings add to evidence suggesting that PA reduction may not be diagnostically relevant to PTSD, whereas NA remains an important target for therapeutic interventions. Moreover, results show that WTC responders can experience and benefit from positive emotion, even if they continue to have PTSD symptoms. Clinical Impact StatementFirst responders with posttraumatic stress disorder (PTSD) experience daily levels of positive affect that are similar to those without the disorder. Given the numerous health benefits associated with the ability to experience positive affect, findings suggest that even after experiencing significant trauma, disaster responders with PTSD can nevertheless benefit from interventions that promote positive affect. Moreover, results underscore how circadian patterns of affect can be anticipated and addressed in treatment of PTSD.

Dampening of positive affect is associated with posttraumatic stress following stressful life events

“…Also considering evidence that PTS does not coincide with an inability to experience PA per se (Dornbach-Bender et al, 2020 ), it seems that difficulties maintaining PA (occurring later in the emotion-generation time line) is more strongly connected with PTS than difficulties experiencing PA in the first place (occurring earlier in the emotion-generation time line). Speculatively, it is possible that dampening of PA contributes to re-experiencing because it limits the interruption of (and hence strengthens) the activation of images of the negative event on confrontation with event-related cues, contributes to avoidance because it blocks the broadening of (and thus narrows) one’s thought–action repertoire needed to confront situations reminding of the event, and maintains arousal and other signs of hypervigilance by diminishing health-protective biological responses (Dornbach-Bender et al, 2020 ; Tugade & Fredrickson, 2004 ). Future preferably longitudinal research is needed to further examine the linkage of dampening with different symptom clusters of PTS and mechanisms mediating this linkage.…”

“…PA dysregulation can take various forms; it may occur in processes associated with the emergence of PA (‘antecedent-focused processes’ such as decreased engagement in potentially positive activities) and processes associated with the modulation of emotions (‘response-focused processes’ including non-attendance to, and negative appraisals of positive emotions). Furthermore, PA dysregulation may include both too little upregulation and too much downregulation of PA and may consider stable, trait-like proclivities as well as temporary, state-based responses (Carl et al, 2013 ; Dornbach-Bender et al, 2020 ). Although studies indicated that PTS is not associated with an inability to experience PA per se (Dornbach-Bender et al, 2020 ), there is gradually growing evidence that the dysregulation of PA does contribute to PTS.…”

“…Furthermore, PA dysregulation may include both too little upregulation and too much downregulation of PA and may consider stable, trait-like proclivities as well as temporary, state-based responses (Carl et al, 2013 ; Dornbach-Bender et al, 2020 ). Although studies indicated that PTS is not associated with an inability to experience PA per se (Dornbach-Bender et al, 2020 ), there is gradually growing evidence that the dysregulation of PA does contribute to PTS. For instance, in a study among women exposed to domestic violence, Weiss, Dixon-Gordon, Peasant, and Sullivan ( 2018 ) found that higher levels of nonacceptance of positive emotions, difficulties engaging in goal-directed behaviours, and difficulties to control impulsive behaviours when experiencing positive emotions were related to more severe PTS.…”

“…The current study sought to further our understanding of PA dysregulation in PTS. This was deemed relevant, considering the growing acknowledgement in theorizing and research that the dysregulation of positive processes, including memories, thoughts, and feelings plays an important role in PTS and that targeting positive processes may have incremental utility for interventions for PTS (Contractor et al, 2018 ; Dornbach-Bender et al, 2020 ). We sought to expand prior work in a number of ways.…”

Ecological momentary assessment of self-rated health, daily strategies and self-management app use among trauma-exposed adults

“…Koch, Liedl, Takano, & Ehring, 2020 ; Pacella, Girard, Wright, Suffoletto, & Callaway, 2018 ; Pfaltz et al, 2010 ) and positive and negative emotions (e.g. Dornbach-Bender et al, 2020 ; Van Voorhees et al, 2018 ). Few studies have investigated health, rather than symptoms, but related topics such as self-esteem and well-being have been explored (Kashdan, Breen, & Julian, 2010 ; Kashdan et al, 2006 ).…”