Risk and Resiliency in Posttraumatic Stress Disorder: Distinct Roles of Anxiety and Disgust Sensitivity
Bunmi O. Olatunji, Thomas Armstrong, Qianqian Fan, and Mimi Zhao
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G.A.P.S. Sachini O. Pathiraja
Olantunji B. O., Armstrong T., Fan Q., & Zhao M. (2014). Risk and resiliency in posttraumatic stress disorder: Distinct roles of anxiety and disgust sensitivity. Psychological Trauma: Theory, Research, Practice and Policy, 6(1), 50-55. doi: 10.1037/a0029682
Introduction
The research review is based on a study which conducts an experiment to examine the outcomes of disgust sensitivity and anxiety sensitivity on posttraumatic stress disorder (PTSD) of veterans (Olantunji, Armstrong, Fan & Zhao, 2014). Posttraumatic stress disorder is an anxiety disorder that occurs when the symptoms after a traumatic event exists for a period of more than a month. It has been found out that twenty percent of the 1.6 million individuals in the United States of America that go for war have developed PTSD symptoms (Comer, 2010). The major purpose of the experiment is to clarify whether disgust sensitivity and anxiety sensitivity act as resilient factors or risk factors for the enhancement of PTSD of veterans. Symptom measures were used to test the effects of disgust sensitivity and anxiety sensitivity on PTSD of veterans (Olantunji et al., 2014).
Associated Theories
According to other studies conducted, anxiety sensitivity is considered as a risk causing element for PTSD (Olantunji et al., 2014). Anxiety sensitivity is the likelihood to misinterpret the sensations of the body and make illogical assumptions to consider those sensations as harmful (Comer, 2010). Moreover, studies have also shown that disgust sensitivity enhances conditions of anxiety. Disgust sensitivity is the likelihood to consider the disgust emotion disagreeable and unpleasant. However, there are no studies conducted to prove that disgust sensitivity as a risk causing agent for PTSD (Olantunji et al., 2014).
Disgust sensitivity and anxiety sensitivity may lead to a PTSD via an integral predisposition to stress which is activated by a certain level of trauma and stress. According to taxometrics, disgust sensitivity and anxiety sensitivity exists in individuals ranging from a lower degree levels to higher degree levels. Furthermore, resiliency helps an individual to sustain a stable life when interacting with situations that cause stress and trauma. However, a small amount of studies have been conducted and there is no clarity as to whether lower degrees of disgust sensitivity and anxiety sensitivity contribute to resiliency (Olantunji et al., 2014).
Hypotheses
There are two null hypotheses in this experiment, H0: PTSD veterans would score low on disgust sensitivity and anxiety sensitivity than nonveterans and veterans who do not have PTSD but who were exposed to trauma, if the disgust sensitivity and anxiety sensitivity are interpreted as risk factors and, H1: PTSD veterans would score high on disgust sensitivity and anxiety sensitivity than nonveterans and veterans who do not have PTSD but who were exposed to trauma, if the disgust sensitivity and anxiety sensitivity are interpreted as risk factors. The two alternative hypotheses in the experiment are, H1: “anxiety sensitivity and disgust sensitivity represent risk factors, it was predicted that veterans with PTSD would score higher than trauma exposed veterans without PTSD and healthy nonveteran controls.” and H1: “If these traits represent resilient factors, however, it would be predicted that trauma-exposed veterans without PTSD will score lower than veterans with PTSD and healthy nonveteran controls” (Olantunji et al., 2014).
Sample
Participants for the study were given informed consent in writing before conducting the study by a specialized research assistant in the review board of the Vanderbilt Institution. The sample consists of 21 PTSD veterans who fulfilled the diagnostic criteria, 16 veterans that did not fulfill the criteria for PTSD but met the requirements for “combat specific criterion A1 of the DSM diagnosis for PTSD” and a control group of 22 nonveterans that did not have any diagnoses. Participants for the study were taken from veteran service advertisements and via referrals from veteran services. The diagnoses were supported by Mini International Neuropsychiatric Interview (MINI). MINI assesses seventeen Axis 1 disorders via an organized clinical interview supervised by clinicians of master and doctorate levels trained with the guidance of a clinical psychologist. According to PTSD comorbidity, most of the PTSD veterans (81%) had a minimum of one extra Axis 1 diagnosis, 71% consisted of an additional anxiety disorder and 24% consisted major depressive disorder (Olantunji et al., 2014).
Method
The participants chosen for the study had to complete a diagnostic interview and symptom measures were taken via a computer in a laboratory room. The assessments of symptoms were conducted through a Post-Traumatic Cognitions Inventory (PTCI), Physical Concerns subscale of the Anxiety Sensitivity Index-3 (ASI-3), Disgust Sensitivity subscale of the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R) and the Expressive Suppression subscale of the Emotion Regulation Questionnaire (ERQ). PTCI is a measure of 36 items and is used to assess thinking patterns and beliefs related to trauma. Internal consistency of PTCI in the conducted study was ?=.99 which indicates that internal consistency was exceptional. Physical Concerns subscale of the ASI-3 is a measure of 6 items in which the fear of reactions related to physical anxiety is assessed according to their beliefs on harmful outcomes. Exceptional internal consistency of ?=.92 was obtained by the study via this measure. The Disgust Sensitivity subscale of the DPSS-R is a measure of 8 items which assesses how unpleasant a person feels when considering disgusting events and experiences. ?=.84 internal consistency was obtained by the study through this measure. The Expressive Suppression Subscale of the ERQ is a measure of 4 items assessing different suppression by individuals and it has an internal consistency of ?=.69 by the study which was satisfactory (Olantunji et al., 2014).
Research Design
In this experiment, there are two experimental groups that is a group consisting of individuals with PTSD and a group consisting of individuals without PTSD. The control group consists of non veterans (Olantunji et al., 2014).
Independent variables
The independent variable is the exposure of the individual to PTSD. PTSD veterans, combat specific veterans without PTSD and nonveterans were used as the manipulated variable (Olantunji et al., 2014).
Dependent variable
The dependent variables of the study were scores on disgust sensitivity and anxiety sensitivity (Olantunji et al., 2014).
Data Analysis
Anxiety sensitivity group differences were analyzed by ANOVA which is a univariate valence analysis on the physical concerns subscale of the ASI-3 and its suppression of expressive emotion outcomes were analyzed by ANCOVA which is the covariance analysis on ERQ. Disgust sensitivity group differences were also analyzed by ANOVA on the subscale of disgust sensitivity of DPSS-R and its suppression of expressive emotion outcomes were analyzed by ANCOVA on ERQ (Olantunji et al., 2014).
Results
With the assessment of PTCI, PTSD veterans scored further negative thinking patterns related to trauma than the PTSD lacking veterans. According to ERQ scores, PTSD veterans scored very high suppression of expressive emotion outcomes than the non veterans and PTSD lacking veterans. There was not much of a difference of suppression of expressive emotional outcomes between non veterans and PTSD lacking veterans (Olantunji et al., 2014).
With the analysis, it has been found out that PTSD veterans have a considerably high level of anxiety sensitivity than nonveterans and PTSD lacking veterans. In contrast, there was no considerable difference in anxiety sensitivity (p=.99) of nonveterans and PTSD lacking veterans (Olantunji et al., 2014). Furthermore, even after group differences control in the suppression of expressive emotion outcomes, it has been found out that PTSD veterans have a considerably high level of anxiety sensitivity than nonveterans and PTSD lacking veterans (ps<0.04). Also, there was no considerable difference in anxiety sensitivity (p=.96) of nonveterans and PTSD lacking veterans (Olantunji et al., 2014).
With the analysis, it has been found out that PTSD lacking veterans have a considerably low level of disgust sensitivity than nonveterans and PTSD veterans although there was no considerable difference in disgust sensitivity (p=.14) of nonveterans and PTSD veterans (Olantunji et al., 2014). Moreover, even after group differences control in the suppression of expressive emotion outcomes, it has been found out that PTSD lacking veterans have a considerably low level of disgust sensitivity than nonveterans and PTSD veterans (ps<0.05). Also, there was no considerable difference in disgust sensitivity (p=.11) of nonveterans and PTSD veterans (Olantunji et al., 2014).
Discussion
According to the analyzed results, having more anxiety sensitivity can lead to a risk factor of having PTSD and having low degrees of disgust sensitivity can act as a protective factor against the creation of PTSD. When considering previous researches, the results of this study match that PTSD veterans have more excessive levels of anxiety. Also, lower degrees of anxiety can act as a resilient factor for PTSD which is the opposite aspect of having excessive degrees of anxiety that can lead to a risk factor. Moreover, traumatic events exposure can give rise to disgust reactions such as a veteran handling dead bodies. The results of the study shows that disgust anxiety at a low level can pave the way to a resilient factor for PTSD and help the person to cope up with events related to trauma (emotional hardiness). Furthermore, the ineffectiveness of the affective states of disgust and anxiety can lead to PTSD but the findings after emotional suppression in the study showed that PTSD lacking veterans with lower degrees of sensitivity to disgust can be considered as an artifact when compared with the control group of nonveterans having higher degrees of sensitivity to disgust (Olantunji et al., 2014).
Limitations
Disgust sensitivity is seen as a factor that protects against PTSD but logical judgments and conclusions must be done with the limitations of the study. For instance, generalizability of the results to PTSD is limited because of the participants exposed to traumas related to war. Also, disgust sensitivity can be seen not only in trauma related to war but also in various other traumas. The results of the study showed that PTSD veterans have high anxiety sensitivity and PTSD lacking veterans have low disgust sensitivity but it is not clearly evident that it is because of the exposure of trauma (Olantunji et al., 2014).
Suggestions
In light of obtaining more accurate results, exposure to a variety of traumas and exploring the resilient and risk factors of anxiety sensitivity and disgust sensitivity that contributes to the PTSD can be a promising area for future research (Olantunji et al., 2014).
References
Comer, R., (2010). Abnormal Psychology (7th ed.). New York: Worth Publishers.
Olantunji B. O., Armstrong T., Fan Q., & Zhao M. (2014). Risk and resiliency in posttraumatic stress disorder: Distinct roles of anxiety and disgust sensitivity. Psychological Trauma: Theory, Research, Practice and Policy, 6(1), 50-55. doi: 10.1037/a0029682
