Emotion regulation difficulties have been implicated in a wide range of clinically-relevant difficulties, including the development, maintenance, and/or exacerbation of symptoms of posttraumatic stress disorder (PTSD). Yet, despite evidence that individuals may experience dysfunction across both positive and negative emotions, past investigations have focused almost exclusively on difficulties regulating negative emotions in PTSD. Given that difficulties regulating positive emotions are often overlooked in clinical settings, it is critical that research explore the role of difficulties regulating positive emotions in PTSD.
Thus, one goal of the current study was to examine whether PTSD was related to difficulties regulating positive emotions across three domains assessed by the Difficulties in Emotion Regulation Scale-Positive (DERS-Positive; Weiss, Gratz, & Lavender, 2015): nonacceptance of positive emotions, difficulties engaging in goal-directed behaviors when experiencing positive emotions, and difficulties controlling impulsive behaviors when experiencing positive emotions.
A second goal of the current study was to begin to identify the potential consequences of difficulties regulating positive emotions in PTSD. Individuals with PTSD are more likely to engage in a wide range of risky, self-destructive, and health-comprising behaviors, including risky sex. Given evidence for the underlying role of positive urgency (i.e., the tendency to engage in rash action in response to extreme positive affect) in the relation between PTSD symptoms and risky behaviors in general (Weiss, Tull, Sullivan, Dixon-Gordon, & Gratz, 2015), we examined whether the domains of difficulties regulating positive emotions assessed by the DERS-Positive accounted for the relation between PTSD symptoms and risky sex.
Participants were 95 trauma-exposed young adults who completed self-report questionnaires assessing difficulties regulating positive emotions (Difficulties in Emotion Regulation Scale-Positive; Weiss et al., 2015), lifetime traumatic exposure (Life Events Checklist; Gray et al., 2004), and past 30-day PTSD symptoms (PTSD Checklist; Weathers, Litz, Herman, Huska, & Keane, 1993), and responded to questions regarding risky sex once a day for 14 days.
Consistent with Blanchard et al.’s (1996) cut-off score, a score of ≥ 44 on the PTSD Checklist was indicative of presumed PTSD. Thirty-nine participants (41%) met criteria for presumed PTSD, with PTSD symptom severity scores ranging from 17 to 85 (M = 41.48, SD = 17.62). One-sixth of participants (17%) reported risky sex at least once over the 14-day reporting period.
We covaried for borderline personality disorder symptoms (because 54% of participants in our sample reported symptoms consistent with probable borderline personality disorder) and age (because older participants reported significantly more risky sex) in our analyses.
Participants with more severe PTSD symptoms reported significantly more nonacceptance of their positive emotions and greater difficulties engaging in goal-directed behaviors and controlling impulsive behaviors when experiencing positive emotions.
Similarly, participants with (vs. without) presumed PTSD reported significantly more nonacceptance of their positive emotions and greater difficulties engaging in goal-directed behaviors and controlling impulsive behaviors when experiencing positive emotions.
Participants who reported more nonacceptance of their positive emotions and greater difficulties controlling impulsive behaviors when experiencing positive emotions reported significantly more risky sex. The indirect effect of PTSD symptoms on risky sex through the pathways of these two domains of difficulties regulating positive emotions was significant, suggesting that nonacceptance of positive emotions and difficulties controlling impulsive behaviors when experiencing positive emotions account for the relation between PTSD symptoms and risky sex.
Our study is the first study to explore the nature and consequences of difficulties regulating positive emotions in PTSD. Our results suggest that individuals with PTSD symptoms are more likely to take a judgmental and evaluative stance towards their positive emotions (e.g., judging them as bad), as well as exhibit difficulties engaging in goal-directed behaviors and controlling impulsive behaviors in the context of positive emotions. Moreover, we found that two domains of difficulties regulating positive emotions, nonacceptance of positive emotions and difficulties controlling impulsive behaviors when experiencing positive emotions, accounted for the relation between PTSD symptom severity and risky sex. These findings highlight the potential utility of targeting difficulties regulating positive emotions in treatments aimed at reducing PTSD symptoms and related risky sex.
Discussion Questions
- PTSD was related to greater difficulties regulating positive emotions. However, items on the measure of difficulties regulating positive emotions refer specifically to emotion dysregulation in the context of happiness. Might the relationships examined here differ as a function of positive emotional state (e.g., happiness vs. excitement vs. pride)?
- What factors should you consider when targeting difficulties regulating positive emotions in the treatment of PTSD symptoms and related risky sex?
Author Biography
Nicole H. Weiss, Ph.D., is an Associate Research Scientist in the Department of Psychiatry at Yale University School of Medicine. Her research and clinical interests focus on the role of emotion dysregulation in posttraumatic stress disorder and related risky, self-destructive, and health-comprising behaviors (e.g., substance use, risky sex, aggression).
Katherine L. Dixon-Gordon, Ph.D., is an Assistant Professor in the Department of Psychological and Brain Sciences at the University of Massachusetts Amherst. Her research and clinical interests focus on the role of emotion dysfunction in borderline personality and related self-destructive and problem behaviors (e.g., substance use, self-harm).
Courtney Peasant, Ph.D., is a NIMH-funded postdoctoral fellow at the Center for Interdisciplinary Research on AIDS at Yale University. Her research explores how the intersection of gender-based violence, mental health challenges, and substance use influences HIV risk among women.
Tami P. Sullivan, Ph.D., is an Associate Professor of Psychiatry, Director of Family Violence Research and Programs, and Co-Director of the Division of Prevention and Community Research at Yale University School of Medicine. Her research is centered on individual- and system-level factors that affect the well-being of women victims of domestic violence.