(PS4-B36) PTSD and Emotion Dysregulation: Associations Between Symptom Clusters and Treatment Responses in Computerized-cognitive Training

Introduction: Recent literature highlights a growing prevalence of mental health symptomology in individuals in relation to the COVID-19 pandemic, including posttraumatic stress disorder (PTSD). Individuals with PTSD display higher levels of emotional dysregulation than those without, which can lead to increased intrusive memories, sympathetic activation, and negative affect. Emotional suppression and cognitive reappraisal are two methods of emotion regulation processes implicated in mental health conditions like PTSD. The extent to which emotional suppression and reappraisal are linked to specific symptom clusters remains understudied. Moreover, the effect of treatment on emotion regulation is unclear, particularly with regard to virtually-administered treatments that have become increasingly popular during the pandemic. We sought to examine the associations between PTSD symptom clusters and emotion regulation in individuals who completed a computer-administered cognitive training program designed to treat PTSD, and to evaluate whether this cognitively-based intervention would improve self-reported emotion regulation.

Methods: Participants (n=17) were randomized to complete 16 sessions of either a challenging working memory training program or a similar but less difficulty working memory program (data from conditions was combined for this analysis). Measures of PTSD severity, depression comorbidity, and emotion regulation features were collected before and after treatment utilizing the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), MINI Neuropsychiatric Interview, and emotional regulation questionnaire (ERQ), respectively.

Results: Reappraisal was significantly and negatively associated with the negative cognition and mood cluster of PTSD symptoms (p< .01). No other associations between reappraisal symptoms or suppression and symptoms were observed after correcting for multiple comparisons. There were no statistically significant associations between emotion regulation and depression comorbidity. A general linear model showed modest evidence of emotional suppression reductions following treatment, p=.061, which was reduced when accounting for change in PTSD symptom severity, p=.46. No statistically significant change in reappraisal was found.

Conclusion: Low endorsement of reappraisal was linked to worse symptoms related to low mood and negative beliefs about the self, others, and the world. This is consistent with the symptom cluster presenting as inflexibility with generating alternative explanations of events and situations, which closely aligns with the cognitive process of reappraisal. The lack of association with major depression comorbidity point to potential specificity to PTSD rather than a general negative emotionality. Finally, the computerized cognitive treatment may be related to improving ratings of emotional suppression, though effects seemed to be driven by reductions in clinical symptoms. Future investigation is needed to determine whether decreases in emotional suppression drive down the severity of PTSD symptoms or vice versa within a larger sample and to evaluate potential treatment options that better target emotion regulation.