An Investigation of Emotional Numbing in Veterans with Posttraumatic Stress Disorder Symptoms Open Access

Evans, Amanda Pema Brown (2016)

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Despite significant advances in empirically supported treatments for posttraumatic stress disorder (PTSD), many PTSD sufferers do not fully remit. Research has increasingly focused on examining the role deficits in emotional functioning may play among those who develop chronic PTSD. Residual emotional numbing and associated functional impairment are commonly reported, yet emotional numbing remains poorly defined and poorly understood. Most studies have relied on ratings of three DSM-IV Cluster C numbing symptoms as the only measure, and very few published studies have reported on psychophysiological correlates of self-reported emotional numbing. The present study investigated correlates of emotional numbing within a sample of male veterans with trauma histories (n = 47) using a recently developed, more comprehensive measure of emotional numbing. Consistent with predictions, self-reported emotional numbing was associated with higher self-reports of attachment insecurity, relationship distress, and lower compassion for self and others. Contrary to predictions, emotional numbing was positively associated with heart rate variability and negatively associated with heart rate during resting baseline and presentation of emotional stimuli, indicating diminished physiological responding. Psychophysiological arousal and self-reported arousal were not associated with one another, and physiological arousal did not differ across conditions that involved presentation of positive and negative images. These results did not provide support for the prevailing notion that psychophysiological hyperreactivity characterizes PTSD samples. A secondary aim of the study was to investigate the credibility and acceptability of a compassion meditation intervention targeting emotional numbing symptoms in a subgroup of participants who reported a history of diagnosed PTSD and interest in receiving treatment for emotional numbing symptoms (n = 10). In this small pilot, veterans who completed Cognitively Based Compassion Training (CBCT) did not report increased subjective feelings of compassion for self and others, as had been hypothesized, but did report significantly decreased numbing and PTSD symptoms. Moreover, CBCT was rated as highly acceptable and useful, and drop out was low. Thus, further evaluation of the potential for compassion meditation to address emotional numbing is warranted.

Table of Contents

Dissertation Overview. 7

Background Literature Review. 9

Emotional Numbing in PTSD. 10

Correlates and Consequences of Emotional Numbing. 12

Compassion Training as a Novel Intervention for Residual PTSD Symptoms. 22

Research Aims and Hypotheses. 26

Method. 28

Participants and Procedures. 28

Measures. 30

Baseline self-report measures. 30

Psychophysiological measures and laboratory tasks. 35

Credibility, motivation, acceptability, and engagement with CBCT. 38

Intervention. 40

Statistical Analyses. 40

Results. 42

Preliminary Analyses. 42

Participant Enrollment and Flow. 43

Hypothesis 1a: Associations Between Emotional Numbing Measures. 45

Hypothesis 2a: Associations Between Emotional Numbing and Cardiac Variables. 45

Hypothesis 2b: Associations Between Emotional Numbing and Self-Reported Arousal. 48

Hypothesis 2c: Associations Between Emotional Numbing and Relational Functioning. 49

Hypothesis 2d: Associations Between Emotional Numbing and Compassion. 49

Hypothesis 3a: CBCT Engagement and Satisfaction. 50

Hypothesis 4a: Exploring Pre-Post Change Following CBCT. 51

Discussion. 52

Strengths and Limitations. 63

Future Directions. 66

Conclusions. 68

References. 69

Appendix A: Tables. 87

Appendix B: Figures. 95

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