Individuals with PTSD Experience Difficulties Regulating Positive Emotions
Nicole H. Weiss, Ph.D., Katherine L. Dixon-Gordon, Ph.D., Courtney Peasant, Ph.D., & Tami P. Sullivan, Ph.D.
September 10, 2018
Emotion regulation has been increasingly viewed as a transdiagnostic factor with relevance to development and treatment of several forms of psychopathology, including posttraumatic stress disorder (PTSD). However, existing research in this area has focused almost exclusively on difficulties stemming from negative emotions. Recent work suggests that individuals may also experience difficulties regulating positive emotions. These difficulties may include nonacceptance of positive emotions (e.g., “When I’m happy, I become scared and fearful of those feelings”), difficulties controlling impulsive behaviors when experiencing positive emotions (e.g., “When I’m happy, I have difficulty controlling my behaviors”), and difficulties engaging in goal-directed behaviors in the context of positive emotions (e.g., “When I’m happy, I have difficulty focusing on other things”).
These difficulties regulation positive emotions may be particularly pronounced among individuals with PTSD. For instance, among individuals with PTSD, physiological arousal stemming from positive emotions may be experienced as aversive because of its relation to trauma symptoms and distress. Thus, individuals with PTSD may be less accepting of positive emotional experiences. Alternatively, positive emotions may lead to disadvantageous and impulsive decision making in PTSD. Thus, individuals with PTSD may be more likely to experience difficulties controlling impulsive behaviors and engaging in goal-directed behaviors in the context of positive emotions. 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.
The 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 controlling impulsive behaviors when experiencing positive emotions, and difficulties engaging in goal-directed behaviors when experiencing positive emotions.
Participants were 210 women victims in a domestic violence case. The sample was diverse (49% African American), and the average age was 36. Nearly one-fourth met criteria for probable PTSD. Participants completed self-report questionnaires assessing difficulties regulating positive emotions (Difficulties in Emotion Regulation Scale – Positive; Weiss et al., 2015) and past 30-day PTSD diagnostic criteria and symptomatology (Posttraumatic Stress Diagnostic Scale; Foa, Cashman, Jaycox, & Perry, 1997).
Results revealed that participants with more severe PTSD symptoms (overall and for the intrusion, avoidance/emotional numbing, and hyperarousal clusters) 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 probable PTSD diagnosis reported significantly higher levels of difficulties engaging in goal-directed behaviors and controlling impulsive behaviors when experiencing positive emotions than participants without a probable PTSD diagnosis.
Our study is the first study to explore the nature 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. These findings highlight the potential utility of targeting difficulties regulating positive emotions in PTSD treatments.
- PTSD was related to difficulties regulating positive emotions. Might the relations examined here differ as a function of positive emotional state (happiness vs. excitement vs. pride)?
- What potential treatment targets should you consider when addressing difficulties regulating positive emotions in the treatment of PTSD symptoms?
Weiss, N. H., Dixon‐Gordon, K. L., Peasant, C. and Sullivan, T. P. (2018), An Examination of the Role of Difficulties Regulating Positive Emotions in Posttraumatic Stress Disorder. Journal of Traumatic Stress, 31: 775-780. doi:10.1002/jts.22330
Nicole H. Weiss, Ph.D., is an Assistant Professor in the Department of Psychology at the University of Rhode Island and Director of the Study of Trauma, Risk-taking, Emotions, and Stress Symptoms (STRESS) Lab. 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, most notably substance use and HIV/sexual risk.
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 Research Clinical Psychologist at RTI International. 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.