Emotion Dysregulation as a Prospective Predictor of PTSD Following Sexual Assault Molly Franz, M.A., Christina Hein, M.A., Anna Jaffe, M.A., Terri Messman-Moore, Ph.D., Kim Gratz, Ph.D., David DiLillo, Ph.D.

Continuing Medical Education Commercial Disclosure Requirement I, Molly Franz, have no commercial relationships to disclose.

Emotion Dysregulation Emotion dysregulation is a multi-faceted construct (Gratz & Roemer, 2004; Gross, 1998; Seligowski & Orcutt, 2015) Unwillingness to experience emotional distress (i.e., avoidance) Difficulty modulating physiological reactions and behaviors when distressed Lack of awareness, understanding, and acceptance of emotions Difficulty utilizing appropriate coping strategies for mitigating emotions

PTSD has been conceptualized as a disorder characterized by deficits in adaptive emotion regulation PTSD symptoms Intense distress at exposure to traumatic reminders Avoidance of distressing memories, thoughts, or feelings about the traumatic event Irritable behavior and angry outbursts Persistent negative emotional state Persistent inability to experience positive emotions (i.e., emotional numbing) (Frewin & Lanius, 2006; Litz, Orsillo, Kaloupek, & Weather, 2000)

PTSD and Emotion Dysregulation Growing literature demonstrates associations between emotion dysregulation and PTSD; yet existing research is largely cross-sectional. Prospective research is rare but suggests that emotion regulation prior to trauma plays a role in the development and maintenance of PTSD. Emotion regulation difficulties prior to a mass shooting prospectively predicted PTSD symptoms in the acute aftermath of the shooting, and eight months later. Similar work in different traumatized populations (e.g., victims of sexual assault) is warranted. (Bardeen et al., 2013; Marx & Sloan, 2005; Nightingale & Williams, 2000; Seligowski et al., 2015)

Goal of the Present Study Expand upon prior literature by: Utilizing prospective study design Assessing impact of emotion dysregulation on sexual assault-related PTSD, specifically Examining multiple facets of emotion dysregulation Therefore, we aim to… Investigate the role of pre-trauma emotion regulation difficulties in the development of PTSD following exposure to sexual assault.

Sample Taken from a larger NICHD-funded longitudinal study on emotion dysregulation and sexual revictimization among young women (N=491) in the community. Study criteria: Among women who reported experiencing a new incident of sexual assault at a given wave, prior wave emotion dysregulation was examined as a prospective predictor of sexual assault-related PTSD symptoms. 73 women met criteria for inclusion

Sample Demographics Age: 18-25 (M = 21.5, SD = 2.22) Race/Ethnicity: Primarily white (65.8%) or African American (26%). Other races/ethnicities represent less than 5% of sample. Education: Half the sample were full-time students (48.6%). Months between pre- and post-assessment: 1.24 to 21.05 months (M = 5.52, SD = 3.40) Prior victimization: The majority of the sample (91%) experienced childhood sexual abuse or adult sexual assault prior to the index assault.

Measures Emotion Regulation Measures Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004) Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007) Affect Intensity Measure (AIM; Larsen, 1984) – Mean negative intensity/reactivity scale used in analyses. The Emotion Amplification and Reduction Scales (TEARS; Hamilton et al., 2009) – Emotion Reduction scale used in the current study. Difficulties in Emotion Regulation (DERS; Gratz & Roemer, 2004)

Measures (cont). Posttraumatic Stress Disorder Checklist for DSM-IV (PCL-C; Blanchard et al., 1996) Severity of Index Sexual Assault: Computed by summing degree of force used (e.g., verbal tactics, physical force), and severity of acts (e.g., fondling only, oral sex, vaginal/anal penetration). Prior Victimization: Prior experience of child sexual abuse or adult sexual assault.

Data analytic approach A structural equation model using maximum likelihood estimation with robust standard errors (MLR) was estimated using Mplus 7 software (Muthén & Muthén, 2010). Confirmatory factor analysis was conducted to determine the fit of the measurement model. Measurement and structural models were tested simultaneously. The Comparative Fit Index (CFI), the Root Mean Square Error of Approximation (RMSEA), and the Standard Root Mean Residual (SRMR) were used to assess global fit. (Bentler, 1990; Browne & Cudeck, 1993; Byrne, 2001; Hu & Bentler, 1999)

Data Analytic Approach Three latent variables based on prominent models of emotion dysregulation. Acknowledgement of Emotions (1) DERS –Awareness, (2) DERS –Clarity, (3) DERS – Nonacceptance, (4) AAQ Experience of Emotions (1) ASI, (2) AIM-Negative emotion/negative reactivity, (3) TEARS-Reduction Management of Emotions (1) DERS—Limited access to strategies, (2) DERS—Impulse control difficulties (3) DERS—Difficulties engaging in goal-directed behaviors Because these three factors were expected to load onto a general construct of emotion regulation, we simultaneously fit a second order latent variable.

Measurement Model CFI = .945 SRMR = .060 RMSEA = .096

Structural Model CFI = .929 SRMR = .063 RMSEA = .082

Discussion Consistent with prior research, greater emotion dysregulation prior to a sexual assault incident prospectively predicted greater PTSD symptoms following the event. Reflects a vulnerability model of PTSD – individuals with poor emotion regulation have a preexisting vulnerability to PTSD symptoms following trauma exposure. Although we derived indicators of emotion dysregulation that loaded highly onto conceptually derived factors, results suggest that different facets of emotion regulation may have tapped into the same construct. (Aldao, Nolen-Hoeksema, & Schweizer, 2010; Bardeen et al., 2013; Elwood, Hahn, Olatunji, & Williams, 2009; Seligowski et al., 2015)

Discussion Clinical Implications: Improving emotion regulation skills early on, particularly for those at heightened risk (e.g., military, first responders, college freshman) could help mitigate the impact of trauma exposure on PTSD development. Limitations: Greater sample sizes are preferred for latent variable analyses. Our small N may have resulted in less stable and less robust estimates of effects. Future Directions: Moderation and mediation analyses may reveal important mechanisms or conditions under which emotion dysregulation predicts PTSD symptoms.

Thank you! Molly Franz, M.A. (University of Nebraska-Lincoln) MollyRFranz@gmail.com