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Emotional Clarity, Anxiety Sensitivity, and PTSD Symptoms Among Trauma-Exposed Inpatient Adolescents

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Abstract

Although several investigations—on primarily adult samples—demonstrate a potential role of emotion dysregulation in the etiology and maintenance of posttraumatic stress disorder (PTSD), investigations into the mechanisms that may underlie these associations in general and among adolescents in particular are lacking. The present study examined associations among emotional clarity (i.e., the extent to which individuals are confused about the specific emotions they are experiencing), (Gratz, Journal of Psychopathology Behavioral Assessment 26(1):41–54, 2004) anxiety sensitivity, and DSM-IV PTSD symptom cluster severity (i.e., re-experiencing, avoidance, and hyperarousal symptoms) in a diverse sample of trauma-exposed inpatient adolescents. It was hypothesized that anxiety sensitivity would underlie association between emotional clarity and PTSD symptoms. Participants (N = 50; 52.0% female; M age = 15.1 years, SD = 0.51; 44% White) completed measures of emotion dysregulation, anxiety sensitivity, and PTSD. Lower emotional clarity was significantly associated with greater total PTSD symptoms, as well as re-experiencing, avoidance, and arousal symptoms. Additionally, there were indirect effects for lack of emotional clarity via anxiety sensitivity in relation to total PTSD symptoms [B = 0.17, SE = 0.08, BC 95% CI (0.04, 0.35)], re-experiencing symptoms [B = 0.15, SE = 0.08, BC 95% CI (0.03, 0.36)], avoidance symptoms [B = 0.12, SE = 0.07, BC 95% CI (0.02, 0.29)], and hyperarousal symptoms [B = 0.17, SE = 0.08, BC 95% CI (0.04, 0.36)]. Reversed models were violated, supporting the direction of hypothesized effects. Difficulties recognizing and accurately understanding emotions may increase risk for PTSD symptoms among trauma-exposed youth. Furthermore, anxiety sensitivity may be a promising intervention target among youth at risk for PTSD, especially among those demonstrating poorer emotional clarity.

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Notes

  1. To evaluate the specificity of the model to DERS-Clarity, exploratory analyses with all DERS subscales were conducted. Only two other DERS subscales were related to our explanatory variable (anxiety sensitivity): DERS-emotional nonacceptance (r = .51, p < .01) and DERS-lack of strategies (r = .31, p = .026). As a result, direct and indirect effects were examined with each of these subscales as separate predictors. The indirect effect of DERS-emotional nonacceptance on PTSD symptoms via anxiety sensitivity was not significant (B = 0.23, SE = 0.15, 95% CI = − 0.03, 0.55). However, the indirect effect of DERS-lack of strategies on PTSD symptoms via anxiety sensitivity was significant (B = 0.19, SE = 0.11, 95% CI = 0.02, 0.47). We thank an anonymous reviewer for suggesting these analyses and comment on their implications in the Discussion.

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Authors and Affiliations

  1. Department of Psychology, University of Houston, Health and Biomedical Sciences Building, Room 373, Houston, TX, 77204, USA

    Andres G. Viana, Abigail E. Hanna, Emma C. Woodward, Elizabeth M. Raines, Daniel J. Paulus & Michael J. Zvolensky

  2. Department of Pediatrics, University of Virginia, Charlottesville, USA

    Erin C. Berenz

  3. Department of Behavioral Sciences, MD Anderson Cancer Center, University of Texas, Houston, TX, 77030, USA

    Michael J. Zvolensky

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  1. Andres G. Viana
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  2. Abigail E. Hanna
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Viana, A.G., Hanna, A.E., Woodward, E.C. et al. Emotional Clarity, Anxiety Sensitivity, and PTSD Symptoms Among Trauma-Exposed Inpatient Adolescents. Child Psychiatry Hum Dev 49, 146–154 (2018). https://doi.org/10.1007/s10578-017-0736-x

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