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Experiential avoidance (EA), or the evasion of unpleasant internal experiences, is key to changes in emotional responsivity in Posttraumatic Stress Disorder (PTSD). EA has been linked to altered negative emotional reactivity in PTSD, but it remains unclear whether EA is linked to altered positive reactivity in PTSD, i.e. anhedonia. Therefore the study examined how manipulating EA influences emotional responsiveness in a non-clinical adult population (N=74). Positive emotion reactivity (self-report and psychophysiology) was measured before and after viewing a laboratory analogue trauma induction, with half of participants instructed to adopt the detached protector (DP) mode as an example of EA during trauma viewing and half of participants in an uninstructed control condition. Following the DP mode instructions reduced negative emotion experience during the trauma induction, relative to the control condition. However counter to prediction, there was no carry over onto blunted positive emotion experience or psychophysiological response in the experimental condition (relative to the control condition) when recalling positive memories and imagining positive future events. No significant relationships were identified between trait EA levels and anhedonia symptoms or pre-manipulation positive emotional responsiveness in the laboratory. Overall, the current findings offer no support for the hypothesis that EA contributes to anhedonia.

Elucidating factors associated with adherence to treatment for physical and mental health conditions is important, given well-documented associations between non-adherence and poor treatment outcomes. Researchers have worked to identify such factors; however, most studies focus on adherence to medical, rather than, psychological treatments. Clarifying variables that predict adherence to psychotherapy is particularly important for individuals with post-traumatic stress disorder (PTSD), for whom treatment, which typically involves exposure to trauma-related stimuli and imagery, can be aversive. It may consequently be associated with high nonadherence rates, even though studies indicate that greater adherence to PTSD treatment relates to better treatment outcomes. Research needs to identify factors that increase or decrease the likelihood that affected individuals will enter and complete therapy. Although several studies to date have examined adherence to treatment for PTSD, this literature is limited on several fronts. First, studies on psychotherapy adherence have identified few consistent predictors of treatment adherence. Second, adherence to psychotherapy is rarely a central focus of treatment-related research; more typically, researchers treat adherence as secondary in importance to treatment outcomes. Third, little research on psychotherapy adherence has been theoretically driven. Fourth, little adherence research has focused on combat veterans with PTSD, who tend to have particularly poor treatment outcomes. Especially lacking is knowledge about predictors of adherence in veterans who have recently returned from combat; most research focuses on veterans of the Vietnam War, many of whom were initially traumatized decades earlier. The study tested the hypothesis that elevated reports of a specific type of PTSD symptom--avoidance/emotional numbing-- predicted poorer adherence to treatment in 160 veterans who received psychotherapy. No significant associations between avoidance and emotional numbing symptoms and adherence were found. However, emotional numbing was negatively related to psychotherapy adherence. Other variables typically related to PTSD and treatment outcomes were found to be important predictors of psychotherapy adherence and completion/noncompletion of therapy.

Veterans suffering from posttraumatic stress (PTSD), compared to relative trauma-exposed veterans without PTSD, have more serious relationship problems. Research in the area of combat trauma-related symptoms and intimate partner relationships have to-date, mostly focused on identifying the negative outcomes of trauma but have not elaborated on how the symptoms themselves act as agents in negative relationship functioning. The purpose of this study was to identify a relationship between combat-related PTSD symptoms of insomnia/sleep dysfunction, avoidance/emotional numbing, and intimate partner distress - specifically the mechanisms by which symptoms and distress are maintained or exacerbated. A review of combat trauma and relationship theories indicated that a newly applied theory, Conservation of Resources (COR) could account for specific combat trauma symptomology, the effects of non-PTSD intimate partners’ distress, and the course of these aspects. This study predominately utilized quantitative data for exploratory correlational research. One hundred and fifteen Canadian combat veterans completed self-administered questionnaires that included demographic characteristics, supplementary questions and the study variables: PTSD assessment, dyadic adjustment, and sleep issues. Results indicated that PTSD overall is negatively related to dyadic adjustment, and that avoidance symptoms represent the most detrimental cluster of PTSD in terms of relationship functioning. Although insomnia/sleep dysfunction was not correlated to dyadic adjustment for those with PTSD, it was identified as a contributor to negative relationship functioning through supplementary responses. The study suggests a revised Canadian PTSD prevalence rate of 29%, which is noteworthy when compared to the previous PTSD prevalence rate estimation of 10%. The application of COR theory to combat veterans and relationship functioning is supported by the results of this study. Findings of this study can aid clinicians in the enhancement of couple therapies, draw attention to the need for improved deployment screening and care provisions for military members, and contribute to the breadth of empirical literature.

Objective: Previous studies have established an association between number of traumatic experiences and alexithymia. The present study examines this relationship in a large-scale representative sample of the German general population (N=2,507) and explores the potential mediating effects of posttraumatic symptomatology, particularly avoidance/numbing. Methods: Alexithymia was assessed with the German version of the Toronto Alexithymia Scale (TAS-20). Posttraumatic symptomatology was operationalized by the symptom score of the modified German version of the Posttraumatic Symptom Scale, and traumatic experiences were assessed with the trauma list of the Munich Composite International Diagnostic Interview. Two mediation analyses were conducted. Results: Of the total sample, 24.2% (n=606) reported at least one traumatic experience, 10.6% (n=258) were classified as alexithymic, and 2.4% (n=59) fulfilled the criteria of posttraumatic stress disorder (PTSD). Participants who had survived five or more traumatic experiences had significantly higher alexithymia sum scores. The PTSD symptom cluster avoidance/numbing mediated the association between the number of traumatic experiences and alexithymia. Conclusions: Our findings illustrate an association between number of traumatic experiences and alexithymia and the influence of emotional avoidance and numbing within this relationship. The significant relationship between alexithymia and number of traumatic experiences in a general population sample further supports the concept of multiple and complex traumatization as associated with alexithymia. The results suggest the importance of further investigations determining the causal impact of alexithymia both as a potential premorbid trait and as consequence of traumatization. Lastly, future investigations are needed to clarify alexithymia as a distinct trauma-relevant characteristic for better diagnostics and specialized trauma-integrative therapy.

Objective: Previous studies have established an association between number of traumatic experiences and alexithymia. The present study examines this relationship in a large-scale representative sample of the German general population (N=2,507) and explores the potential mediating effects of posttraumatic symptomatology, particularly avoidance/numbing. Methods: Alexithymia was assessed with the German version of the Toronto Alexithymia Scale (TAS-20). Posttraumatic symptomatology was operationalized by the symptom score of the modified German version of the Posttraumatic Symptom Scale, and traumatic experiences were assessed with the trauma list of the Munich Composite International Diagnostic Interview. Two mediation analyses were conducted. Results: Of the total sample, 24.2% (n=606) reported at least one traumatic experience, 10.6% (n=258) were classified as alexithymic, and 2.4% (n=59) fulfilled the criteria of posttraumatic stress disorder (PTSD). Participants who had survived five or more traumatic experiences had significantly higher alexithymia sum scores. The PTSD symptom cluster avoidance/numbing mediated the association between the number of traumatic experiences and alexithymia. Conclusions: Our findings illustrate an association between number of traumatic experiences and alexithymia and the influence of emotional avoidance and numbing within this relationship. The significant relationship between alexithymia and number of traumatic experiences in a general population sample further supports the concept of multiple and complex traumatization as associated with alexithymia. The results suggest the importance of further investigations determining the causal impact of alexithymia both as a potential premorbid trait and as consequence of traumatization. Lastly, future investigations are needed to clarify alexithymia as a distinct trauma-relevant characteristic for better diagnostics and specialized trauma-integrative therapy.