(PS4-B46) Positive Emotion Dysfunction in Posttraumatic Stress Disorder: A Global or Context-dependent Problem?

Background: Posttraumatic stress disorder (PTSD) is characterized by positive emotion dysfunction. Indeed, DSM-5 includes a persistent inability to experience positive emotion and markedly diminished interest or pleasure as part of the diagnostic criteria of PTSD. Those with PTSD exhibit blunted reactions to a range of positive stimuli including films, faces, autobiographical memories, and monetary rewards (Nawijn et al., 2015). However, the extent to which positive emotion dysfunction is context-dependent remains unclear. Some theories suggest that positive emotion dysfunction in PTSD is a global deficit that results from chronic avoidance (Keane et al., 1985). On the other hand, the context-dependent model suggests that positive emotion dysfunction is inhibited during states of traumatic reexperiencing, but otherwise remains fully intact (Litz et al., 2002). Support for the context-dependent model has been inconsistent and only explored in lab-based settings (Litz et al. 2000; May & Wisco, 2020). In this study, we provide the first test of positive emotion dysfunction in PTSD in daily life.

Method: Trauma exposed community members with (n = 34) and without PTSD (n = 35) were recruited (M_age = 21.71, 79.7% female, 39.1% White) and completed three days of ecological momentary assessment (M_surveys = 27.8 per subject) yielding N = 1917 assessments. PTSD was assessed using the Clinician Administered PTSD Scale for DSM-5. Four questions assessed traumatic reexperiencing (e.g., “I had unwanted memories of the trauma”). Positive events and emotion were measured using single items (“my situation was positive” and “I felt happy”). All experience sampling items anchored to the past 10 minutes and rated from 1 = not at all to 7 = very much. Multilevel models were estimated using Mplus.

Results: First, those with PTSD experienced less positive emotion (happiness) in daily life than controls (β = -1.14, SE = .28, p < .001). Second, within-person main effects models revealed that the more positive a person rated their situation, the more positive emotion they concurrently experienced (β = .53, SE = .04, p < .001), suggesting the presence of positive emotion reactivity in the overall sample. Similarly, in the overall sample, the presence of a trauma reminder predicted lower levels of concurrent positive emotion (β = -.57, SE = .12, p < .001). Third, cross-level interactions showed that the effect of PTSD on happiness was not moderated by how positive the situation was (β = -.06, SE = .08, p = .448) or by the presence of a trauma reminder (β = .31, SE = .17, p = .074). Furthermore, the three-way interaction between PTSD, positivity of the situation, and presence of trauma reminders was not significant (β = .14, SE = .12, p = .249).

Discussion: This is the first study to our knowledge to test positive emotional blunting in PTSD in daily life. Results supported the global model of positive emotion dysfunction such that those with PTSD experience lower average levels of positive emotion. By contrast, we did not find evidence for the context-dependent model of positive emotional dysfunction. We provide recommendations for future research adopting daily life methods, including sampling a more diverse set of positive emotions and more nuanced measurement of positive events.