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OBJECTIVE This study investigated preshooting emotion dysregulation and posttraumatic cognitions as predictors of mental health service utilization ([MHU]; i.e., therapy/medication) among undergraduate women following a campus mass shooting, controlling for time, age, and postshooting posttraumatic stress (PTS) and depressive symptoms. METHOD Undergraduate women (N = 483, Mage = 19.23, SD = 2.39) were engaged in a study when a mass shooting occurred on Northern Illinois University's campus. A separate, longitudinal study was then implemented to monitor postshooting adjustment among these same women. The present study examined predictors of MHU using data from the preshooting assessment and the following postshooting timepoints: 9 months (T1; n = 416); 14 months (T2; n = 416); 20 months (T3; n = 417); 26 months (T4; n = 405); and 33 months (T5; n = 397). RESULTS Multilevel models showed preshooting emotion dysregulation and postshooting PTS and depressive symptoms positively predicted increased likelihood of MHU while controlling for covariates. Posttraumatic cognitions initially predicted increased therapy utilization, but this relationship became nonsignificant after accounting for preshooting emotion dysregulation. Preshooting emotion dysregulation also weakened the positive relationship between depressive symptoms and therapy utilization and strengthened the positive relationship between age and therapy utilization. CONCLUSIONS Preshooting emotion dysregulation and postshooting mental health symptoms were the most robust predictors of increased MHU following a mass shooting. Findings suggest women exposed to a mass shooting engage in treatment when needed, but preexisting emotion dysregulation may serve as a barrier for those who go on to develop depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Existing literature suggests strong positive associations between posttraumatic stress disorder (PTSD) symptoms and emotion regulation difficulties; however, many of these findings are the result of monomethodological approaches (e.g., self-report questionnaires) versus multimethodological approaches. The current study utilized both self-report questionnaires and an emotion regulation choice paradigm (see Sheppes, Scheibe, Suri, & Gross, 2011) to assess various facets of emotion dysregulation in a sample of trauma-exposed undergraduate students with varying levels of self-reported PTSD symptoms (measured by the PTSD Checklist, fifth edition). Method: Data were collected from 83 students who underwent a laboratory paradigm, followed by completion of numerous self-report measures of emotion regulation (e.g., the Difficulties in Emotion Regulation Scale, the Acceptance and Action Questionnaire-II, and the Emotion Regulation Questionnaire). Results: Students with probable PTSD (n = 25) exhibited greater emotion dysregulation on self-report measures compared with students with nonprobable PTSD (n = 58; ηp² ranged from .06 to .42). Additionally, results from the emotion regulation choice paradigm suggested that students with probable PTSD were more likely to exhibit regulatory inflexibility compared with students with nonprobable PTSD (ηp² = .05). In other words, students with probable PTSD were less likely to use reappraisal (vs. distraction) to help regulate their emotions in response to low-intensity negative stimuli compared with students with nonprobable PTSD. Conclusions: Students with probable PTSD report greater perceived emotion regulation difficulties on self-report questionnaires as well as greater behavioral regulatory inflexibility during a laboratory paradigm. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are heterogeneous disorders that share common underlying factors, etiology, and symptoms. A small body of literature suggests common OCD symptom presentations may exist for this comorbid group, yet common comorbid PTSD symptom presentations remain unknown. The current study examined common symptom presentations in individuals with probable comorbid OCD + PTSD compared with those with a sole presentation of probable OCD or PTSD, controlling for overlapping symptoms, using a sample of 133 undergraduates. Individuals who exceeded cutoffs for probable OCD + PTSD endorse more severe OCD symptoms overall but report similar levels of PTSD symptoms compared with the respective diagnostic groups. Logistic regressions found that symptom domains present similarly overall in a comorbid presentation compared with the respective diagnostic groups, yet some OCD symptom domains were significantly more severe in the comorbid group compared with individuals with probable PTSD. Explanations for the unique contributions of symptoms are discussed, and clinical recommendations for addressing these domains are provided.

Objective Alcohol expectancy theory, which examines beliefs about the effects of alcohol on the consumer, is especially relevant for understanding the role of alcohol use in posttraumatic stress disorder (PTSD). Previous research on the relationship between alcohol expectancies and PTSD suggests that greater endorsement of positive alcohol expectancies is positively associated with alcohol use, problem drinking, and increased PTSD symptomatology. The purpose of the current study was to investigate relationships among positive and negative PTSD alcohol expectancies, PTSD symptom clusters, and alcohol use in a sample of undergraduates. Additionally, a 4-factor structure of PTSD alcohol expectancies, based on the supported 4-domain model of PTSD, was examined. Method Participants included 336 undergraduates at a large Midwestern university who completed measures of trauma exposure, PTSD symptomatology, PTSD alcohol expectancies, and alcohol use. Results Moderation analysis found positive alcohol expectancies influenced the relationship between posttraumatic stress (PTS) and alcohol use. Additionally, each of 4 proposed symptom clusters of PTSD alcohol expectancies moderated the association between corresponding PTSD symptom clusters and alcohol use. No support for the utility of negative alcohol expectancies was found. Conclusions The current study provides support for a PTSD symptom domain-specific approach for measuring alcohol expectancies. Though limited in generalizability, this research also provides evidence for positive PTSD alcohol expectancies as an important moderator in the relationship between symptoms of PTS and alcohol, suggesting that perceptions of alcohol's effect on PTSD symptoms confer risk for problematic drinking. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Women are at notable risk for negative reactions from others following sexual victimization which serve to intensify negative post-traumatic outcomes. The current study tested the effectiveness of cognitive bias modification-appraisal (CBM-App) training targeting post-traumatic cognitions theorized to be impacted by positive and negative social support with 45 female undergraduates, grouped by experiencing overall positive or negative post-assault support. Whereas all participants experienced improvements in post-traumatic cognitions at 1-week follow-up, a crossover effect for intrusion symptoms was found; CBM-App training reduced intrusions in participants with negative support experiences yet increased intrusions in participants with positive support experiences. While findings highlight the need for careful selection of post-trauma interventions, the study is the first to integrate findings from CBM-App, sexual assault, and social support literature. Socially relevant post-traumatic cognitions appear to be malleable and may be an important focus of treatment for survivors who experienced negative post-assault support.

Defensive attribution posits that victim blame results from one’s underlying perception of vulnerability. The resulting blame is believed to reduce perceived similarity to the victim and vulnerability to victimization, though extant research has neglected to examine its effectiveness in men and women. The current study employed multigroup analysis structural equation modeling with 618 male and female undergraduates exposed to fictional police reports of a reported rape. The theory was partially supported; among women, defensive attribution of blame effectively reduced perceived vulnerability to sexual victimization, whereas among men, blame had no effect on perceived similarity or vulnerability. Recommendations for interventions to target perceived vulnerability are discussed.

Childhood abuse is a serious and prevalent public health concern, both in the United States and around the world. The association between child abuse and adverse outcomes in adulthood is well-established, with those experiencing abuse more likely to be diagnosed with mental health disorders, including posttraumatic stress disorder (PTSD), into adulthood. One way to conceptualize the relationship between trauma and adverse mental health outcomes in adulthood is through resource loss. Previous research indicates that individuals who have experienced childhood abuse may not adequately develop resources, such as tangible (e.g., money) and intangible (e.g., emotional) support systems, with the loss of these resources associated with decreased ability to cope with distress. The current study investigated the relationship between resource loss and symptoms of posttraumatic stress longitudinally in a sample of women who had experienced both childhood abuse and a mass-shooting event. Results demonstrated that experiencing childhood physical abuse and sexual abuse predicted symptoms of posttraumatic stress after controlling for exposure to the mass-shooting event. Additionally, symptoms of posttraumatic stress and resource loss predicted each other at two time points after the shooting. Findings demonstrate the bidirectional nature of the relationship between posttraumatic stress and resource loss, as well as highlight how effects of childhood abuse can be long-standing and negatively impact psychosocial functioning in women throughout adulthood.

Compared to the depth of research examining the impact of sexual assault disclosure and related responses from others, little is known about the content shared during disclosures. Categorizing survivors as disclosers or nondisclosers disregards the nuanced and complex nature of disclosure. To address this gap, the current studies examined the reliability and preliminary results of the Sexual Assault Inventory of Disclosure (SAID), an inventory of content shared during disclosures and the context in which it was shared. The SAID proved reliable and preliminary findings suggest that perceptions of disclosures as positive or negative are predicted by differences in content and context, above and beyond disclosure recipients' response. The current study also explored gender differences in disclosure. Additional findings, implications, and suggestions for future studies using the SAID are discussed.

Background: A robust relationship has been established between childhood maltreatment and risky substance use. Posttraumatic stress symptoms and callous-unemotional (CU) traits, both of which can b...

Objective The current study sought to investigate whether experiential avoidance (EA) mediates the effect of shame on posttraumatic symptoms (PTS) in a population of trauma-exposed individuals. Given demonstrated gender differences in posttraumatic stress disorder (PTSD), the current cross-sectional study also sought to examine whether gender moderates this mediational proposed effect. EA has been shown to mediate shame and depression symptoms, suggesting that the unwillingness to feel and/or the attempt to control shame may be an important factor in later psychopathological symptoms. Furthermore, EA appears to influence PTS over time. Method Trauma-exposed undergraduates (n = 326, 68.8% male, Mage = 19.35, SD = 2.30) at a large Midwestern university completed measures of shame, EA, and PTS. Results EA was found to fully mediate the relationship between shame and PTS. The role of gender was mixed as it moderated the relationship between EA and PTS such that the effect of EA is stronger for men than women; however, when analyzed with more robust methods, the effect of gender was no longer significant. A competing, flipped mediational model was run to further assess the direction of hypothesized relationships, but shame was not a significant mediator of EA and PTSD symptoms. Conclusions Results provide further evidence for the centrality of EA in maintaining PTS and suggest targeting EA rather than shame in treatment as an avenue for intervention. Future research is needed to investigate gender differences in engagement in EA. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background Deficits in safety signal learning are well-established in fear-related disorders (e.g., PTSD, phobias). The current study used a fear conditioning paradigm to test associations among eye blink startle and event-related brain potential (ERP) latency measures of safety signal learning, as well as the role of cardiac vagal control (a measure of top-down inhibition necessary for safety learning). Methods Participants were 49 trauma-exposed women ages 17 to 28 years. Eyeblink startle response and ERP amplitudes/latencies were derived for conditioned stimuli associated (CS+) and not associated (CS-) with an aversive unconditioned stimulus. ERPs included the P100 and late positive potential (LPP), which index early visual processing and sustained emotional encoding, respectively. Cardiac vagal control was assessed with resting heart rate variability (HRV). Results P100 and LPP latencies for the CS- (safety signal stimulus) were significantly negatively associated with startle to the CS-, but not the CS + . LPP CS- latencies were significantly negatively associated with PTSD Intrusion scores, and this relationship was moderated by vagal control, such that the effect was only present among those with low HRV. Conclusions ERP-based markers of safety signal learning were associated with startle response to the CS- (but not CS+) and PTSD symptoms, indicating that these markers may have relevance for fear-related disorders. Cardiac vagal control indexed by HRV is a moderating factor in these associations and may be relevant to safety signal learning.

Recognizing that alcohol might affect subsequent processing of trauma-related information, this study examined whether high dose alcohol consumption (HDAC) following a campus mass shooting affected the relation between shooting exposure and post-traumatic stress symptoms (PTSS).Female participants (N = 691) recorded levels of physical exposure to the shooting event, alcohol use, and PTSS 1 month following the shooting event and 8 months later.No evidence was found to suggest that pre-shooting HDAC moderated the relationship between trauma exposure and PTSS 1 month following the shooting. HDAC in the month following the shooting predicted less resolution of PTSS 8 months later. Specifically, at higher (but not lower) levels of HDAC, shooting exposure was associated with less reduction in PTSS from 1 to 8 months post-trauma. Several alternate explanations were ruled out.Less reduction in PTSS seems to occur at high levels of both shooting exposure and HDAC. Theoretical implications and directions for future research are discussed.

Self-defense training is consistently linked to psychological benefits for survivors of sexual trauma, yet little is known about how training may uniquely benefit survivors compared with their nonsurvivor peers enrolled in the same course. Path analysis was used to examine how history of sexual trauma impacts pre- and post-training scores on three domains of self-efficacy using a national sample of Rape Aggression Defense (RAD) participants. All participants reported significant increases in self-efficacy domains, and sexual trauma history significantly predicted pre-training interpersonal self-efficacy and post-training self-defense self-efficacy, suggesting that self-defense training confers benefits for survivors above and beyond benefits for other participants.

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5–20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson’s disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations., Post-traumatic stress disorder (PTSD) is a common mental health problem. Here, the authors report a GWAS from the Psychiatric Genomics Consortium in which they identify two risk loci in European ancestry and one locus in African ancestry individuals and find that PTSD is genetically correlated with several other psychiatric traits.

Objective Emerging research shows that event centrality, or the degree to which trauma is perceived as integral to one's worldviews and personal identity, has a substantial impact on trauma recovery. Given that high centrality fosters both distress and growth, additional research on potential moderators that could better distinguish the course of adjustment is needed. This study examined whether differences in psychological flexibility (or the ability to persist in a behavior despite urges to do otherwise) impacted posttraumatic stress symptoms (PTS) and perceived posttraumatic growth (PTG) as event centrality increased. Method One-hundred and 25 college students (52% female) with a history of trauma exposure were recruited from a large Midwestern university. Participants completed an electronic survey for course credit. Results There was a significant interaction between event centrality and psychological flexibility on PTS severity (B = 2.10, p = .003). A simple slopes analysis revealed that low psychological flexibility was associated with greater PTS severity as event centrality increased. Although event centrality and psychological flexibility independently predicted perceived PTG, no interaction effect was observed (B = -4.68, p = .080). Conclusion This suggests that while differences in psychological flexibility may influence PTS severity following highly centralized traumatic experiences it has a more complicated relationship with perceived PTG that requires further investigation. Clinical implications are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

We examined five dimensions of distress tolerance (i.e. uncertainty, ambiguity, frustration, negative emotion, physical discomfort) as prospective predictors of perceived stress. Undergraduate students (N = 135) completed self-report questionnaires over the course of two assessment sessions (T1 and T2). Results of a linear regression in which the five dimensions of distress tolerance and covariates (i.e. T1 perceived stress, duration between T1 and T2) served as predictor variables and T2 perceived stress served as the outcome variable showed that intolerance of uncertainty was the only dimension of distress tolerance to predict T2 perceived stress. To better understand this prospective association, we conducted a post hoc analysis simultaneously regressing two subdimensions of intolerance of uncertainty on T2 perceived stress. The subdimension representing beliefs that "uncertainty has negative behavioral and self-referent implications" significantly predicted T2 perceived stress, while the subdimension indicating that "uncertainty is unfair and spoils everything" did not. Results support a growing body of research suggesting intolerance of uncertainty as a risk factor for a wide variety of maladaptive psychological outcomes. Clinical implications will be discussed.

Although many women do not report sexual victimization as motivation for seeking self-defense training, differences in self-efficacy suggest that self-efficacy deficits may influence survivors' desire to seek training. Lower self-efficacy, thought to negatively influence perceived confidence in one's ability to engage in everyday activities, may relate to avoidance of mundane activities and cause exacerbation of post-traumatic stress symptoms (PTSS). The current study examined a three-way interaction modeling the relationships between history of rape, activities self-efficacy, activities avoidance, and PTSS in a diverse sample of 233 women enrolled in self-defense training. Results suggest that survivors who avoid everyday activities experience increased PTSS, but this effect is mitigated by perceived self-efficacy to engage in these activities. Activities self-efficacy may promote resilience in rape survivors regardless of whether they actually engage in such activities. Training that targets self-efficacy, rather than actual engagement in activities, may be sufficient to reduce PTSS in rape survivors.

OBJECTIVE: Research suggests that 4-factor models of posttraumatic stress disorder (PTSD) may be improved upon by the addition of novel factors, such as Dysphoric Arousal, Externalizing Behaviors, and Anhedonia. However, a novel 7-factor hybrid model has demonstrated superior fit in veteran and undergraduate samples. The current study sought to replicate this finding in a trauma-exposed community sample and examined relations with positive (PA) and negative affect (NA). METHOD: Participants included 403 adults (Mage = 37.75) recruited through Amazon's MTurk. PTSD was measured using the PTSD Checklist-5 (PCL-5). Confirmatory factor analyses were conducted in Mplus. RESULTS: The 7-factor hybrid model demonstrated good fit: CFI =.96, TLI =.95, RMSEA =.06 (90% CI [.05,.07]), SRMR =.03. This model was superior to the 5- and 6-factor models. All factors demonstrated significant relations with PA and NA, the largest of which were the Externalizing Behaviors (with NA) and Anhedonia (with PA) factors. CONCLUSION: Results provide support for the 7-factor hybrid model of PTSD using the PCL-5 in a community sample. FINDINGS replicate previous research suggesting that PTSD is highly related to NA, which has been purported as an underlying dimension of PTSD. It is recommended that future research use clinical measures to further examine the hybrid model. (PsycINFO Database Record (c) 2016 APA, all rights reserved) Language: en

Through its frequent use, a pattern has emerged showing psychometric limitations of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). This 3-part study sought to (a) determine whether these limitations are due to a method effect by rewording all reverse-coded items in a straightforward manner and submitting them to exploratory factor analysis (EFA), and (b) examine the tenability of an adaptation of the original measure. EFA results from Study 1 (N = 743) supported retention of 29 modified items across 5 factors. Consistent with the original theoretical underpinnings of the DERS, Awareness and Clarity items loaded on the same factor. In Study 2 (N = 738), confirmatory factor analysis (CFA) was used to examine the factor structure of the pool of items identified in Study 1. All of the modified subscales clustered strongly with one another and evidenced large loadings on a higher-order emotion regulation construct. These results were replicated in Study 3 (N = 918). Results from Study 3 also provided support for the reliability and validity of scores on the modified version of the DERS (i.e., internal consistency, convergent and criterion-related validity). These findings provide psychometric support for a modified version of the DERS.

The current study sought to examine whether symptoms of posttraumatic stress disorder (PTSD), adolescent sexual assault (ASA), and drinking motivations (e.g., drinking to regulate emotional experiences) mediate the relationship between a history of childhood sexual abuse (CSA) and subsequent alcohol-related problems among college women. Participants were 579 female students at a Midwestern university. Participants were recruited as part of a larger longitudinal study that investigated risk and resiliency factors related to sexual revictimization. Using a serial mediation model, the current study found that the proposed constructs mediated the relationship between CSA and subsequent alcohol-related problems via two separate paths. In one path, CSA was associated with PTSD, which in turn predicted drinking to regulate emotional experiences, which then was related to alcohol-related problems in adulthood. In the second path, CSA was related to ASA, which in turn predicted drinking to regulate emotional experiences, which then was related to alcohol-related problems in adulthood. These results suggest that individuals with a history of CSA are more likely to experience both revictimization in adolescence and PTSD symptoms in adulthood, which may lead to alcohol-related problems via drinking to regulate emotional experiences. These findings suggest the importance of incorporating skills training in adaptive emotion regulation strategies into treatment for individuals with a history of CSA and ASA.

This study examined relations among experiential avoidance, state dissociation during writing, cognitive-emotional processing, and posttraumatic stress in the context of an expressive writing task among 58 undergraduate females who were students at a large midwestern university that had recently experienced a mass shooting. Experiential avoidance significantly predicted reported suppression during the writing task. Additionally, posttraumatic stress symptoms (PTSS) at the time of the writing task were significantly associated with state dissociation, suppression, and the use of positive emotion words during the writing. Finally, at the zero-order level, prospective PTSS were associated with state dissociation and suppression during the earlier writing task. However, in a full regression model, only experiential avoidance and PTSS at the time of the writing task significantly predicted prospective PTSS. Supplemental analyses suggest processes may operate differently across levels of exposure. Findings from the present study provide further support for the role of experiential avoidance, state dissociation during writing, and cognitive-emotional processing in predicting PTSS. Additionally, experiential avoidance may play an important role in how individuals use cognitive-emotional processing to narrate a traumatic event.

Fear-potentiated startle (FPS) paradigms provide insight into fear learning mechanisms that contribute to impairment among individuals with posttraumatic stress symptoms (PTSS). Electrophysiology also has provided insight into these mechanisms through the examination of event-related potentials (ERPs) such as the P100 and LPP. It remains unclear, however, whether the P100 and LPP may be related to fear learning processes within the FPS paradigm. To this end, we tested differences in ERP amplitudes for conditioned stimuli associated (CS+) and not associated (CS-) with an aversive unconditioned stimulus (US) during fear acquisition. Participants included 54 female undergraduate students (mean age = 20.26). The FPS response was measured via electromyography of the orbicularis oculi muscle. EEG data were collected during the FPS paradigm. While the difference between CS+ and CS- P100 amplitude was not significant, LPP amplitudes were significantly enhanced following the CS+ relative to CS-. Furthermore, the LPP difference wave (CS+ minus CS-) was associated with FPS scores for the CS- during the later portion of fear acquisition. These findings suggest that conditioned stimuli may have altered emotional encoding (LPP) during the FPS paradigm. Thus, the LPP may be a promising neurophysiological marker that is related to fear learning processes.

Experiencing repeated trauma can have increasingly detrimental effects on psychosocial functioning after subsequent stressors. These effects may be intensified for victims of interpersonal traumas given that these events are often associated with heightened risk for adverse outcomes. To better understand this relationship, the present study prospectively examined the effect of pre-shooting trauma exposure (i.e., interpersonal vs. non-interpersonal trauma) on psychological functioning (i.e., posttraumatic stress symptoms, depression) following a mass campus shooting. Based on previous research, it was expected that negative appraisals and social support would mediate this relationship. A sample of 515 college women reporting prior trauma exposure was assessed at four time points following the shooting (i.e., pre-shooting, 1-month, 6-months, and 12-months post-shooting). Bootstrap analyses with bias-corrected confidence intervals were conducted. Contrary to expectation, pre-shooting trauma exposure was unrelated to 12-month post-shooting outcomes and neither negative appraisals nor social support at 6-months post-shooting emerged as mediators. Interestingly, a history of non-interpersonal trauma was associated with greater post-shooting family and friend support than a history of interpersonal trauma. Ad hoc analyses showed that pre-shooting symptom severity and level of exposure to the shooting had indirect effects on post-shooting outcomes via post-shooting negative appraisals. These findings support that cumulative trauma, regardless of type, may not have an additive effect unless individuals develop clinically significant symptoms following previous trauma. Trauma severity also appears to play a meaningful role.

Victims of sexual violence are frequently blamed by friends, family, or legal personnel in the aftermath of an attack, with men attributing greater blame on average than women. Victims’ experiences of being blamed may generate a vicious cycle in which they are more likely to be blamed in the future. Moreover, just world beliefs (JWB) have been studied extensively as an underlying cognitive mechanism that predicts greater blame. Studies examining the influence of social support on blame have yet to examine the unique role of JWB on these attributions. The current study examined blame attribution of a fictional rape victim who received either positive, negative, or neutral support from friends and family in a sample of 383 undergraduate men and women. Individually, social support and JWB were both significant predictors of blame, and women were more influenced by social support than men; specifically, gender was a more salient predictor of blame toward the positively supported victim, suggesting that positive support received by friends and family may evoke a domino effect of support from other women. Conditional effects revealed that JWB were most influential on blame when responding to the positively supported victim. Implications and suggestions for future research are discussed.

Schools have become a common incident site for targeted mass violence, including mass shootings. Although exposure to mass violence can result in significant distress, most individuals are able to fully recover over time, while a minority develop more pervasive pathology, such as PTSD. The present study investigated how several pre- and posttrauma factors predict posttraumatic stress symptoms (PTSS) in both the acute and distal aftermath of a campus mass shooting using a sample with known levels of pretrauma functioning (N=573). Although the largest proportion of participants evidenced resilience following exposure to the event (46.1%), many reported high rates of PTSS shortly after the shooting (42.1%) and a smaller proportion (11.9%) met criteria for probable PTSD both in the acute and more distal aftermath of the event. While several preshooting factors predicted heightened PTSS after the shooting, prior trauma exposure was the only preshooting variable shown to significantly differentiate between those who experienced transient versus prolonged distress. Among postshooting predictors, individuals reporting greater emotion dysregulation and peritraumatic dissociative experiences were over four times more likely to have elevated PTSS 8months postshooting compared with those reporting less dysregulation and dissociative experiences. Individuals with less exposure to the shooting, fewer prior traumatic experiences, and greater satisfaction with social support were more likely to recover from acute distress. Overall, results suggest that, while pretrauma factors may differentiate between those who are resilient in the aftermath of a mass shooting and those who experience heightened distress, several event-level and posttrauma coping factors help distinguish between those who eventually recover and those whose PTSD symptoms persist over time.

The goal of this study was to examine motivations for engaging in risky sexual behaviors (RSBs) and factors that may increase the likelihood of engaging in RSB. RSB was defined as not using condoms during intercourse and having intercourse with poorly known partners, which were treated separately with regard to analyses.Utilizing a weekly diary methodology, the present study examined whether using situation-specific coping strategies (e.g, using alcohol to reduce negative affect and sex to reduce negative affect) and whether subjective reports of intoxication significantly predicted if participants would engage in RSB. Female college students (N = 93) completed a weekly computerized questionnaire for 8 weeks reporting on their sexual behavior, their level of intoxication, and use of strategies (i.e., sex and alcohol) to reduce negative affect at the time of the sexual encounter.Using hierarchical linear modeling, results indicated that level of intoxication was the sole significant main effect related to engaging in RSB; specifically, level of intoxication was positively related to sex with a poorly known partner.Alcohol use, as opposed to motivation for intercourse, is an important area to focus on with regard to prevention of RSB.

Given the significant deleterious effects of stress on psychological and physical well-being, the present two-part study sought to clarify relations among putative vulnerability factors (i.e., anxiety sensitivity, experiential avoidance) for perceived stress. Relations among anxiety sensitivity, experiential avoidance, and perceived stress were examined using a large college student sample (N=400) in Study 1 and were replicated using a large community sample (N=838) in Study 2. As predicted, experiential avoidance moderated the relationship between anxiety sensitivity and perceived stress. Contrary to expectations, simple effects in both studies revealed that anxiety sensitivity shared a significant positive association with perceived stress at low, but not high, levels of experiential avoidance. The moderating role of experiential avoidance was found to be robust to the effects of general distress. Moreover, anxiety sensitivity and experiential avoidance evidenced a differential pattern of relations with perceived stress than was evidenced with related negative affective states (i.e., anxiety and depression). The present results suggest that experiential avoidance appears to be a vulnerability factor of particular importance for understanding the phenomenology of perceived stress. Conceptual and clinical implications are discussed.

Preliminary evidence has demonstrated the benefits of targeting self-compassion in the treatment of posttraumatic stress disorder (PTSD). However, survivors of childhood maltreatment may present with unique challenges that compromise the effectiveness of these and other PTSD treatments. Specifically, childhood maltreatment victims often exhibit a marked fear and active resistance of self-kindness and warmth (i.e., fear of self-compassion). Victims may also attempt to control distressing internal experiences in a way that hinders engagement in value-based actions (i.e., psychological inflexibility). Research suggests that psychological inflexibility exacerbates the negative effects of fear of self-compassion. The present study expanded on previous research by examining the relations among childhood maltreatment, fear of self-compassion, psychological inflexibility, and PTSD symptom severity in 288 college women. As expected, moderate to severe levels of childhood maltreatment were associated with greater fear of self-compassion, psychological inflexibility, and PTSD symptom severity compared to minimal or no childhood maltreatment. A mediation analysis showed that childhood maltreatment had a significant indirect effect on PTSD symptom severity via fear of self-compassion, although a conditional process analysis did not support psychological inflexibility as a moderator of this indirect effect. A post hoc multiple mediator analysis showed a significant indirect effect of childhood maltreatment on PTSD symptom severity via psychological inflexibility, but not fear of self-compassion. These findings highlight the importance of addressing fear of self-compassion and psychological inflexibility as barriers to treatment for female survivors of childhood maltreatment.

Objective Healing from trauma has been conceptualized as either facing the trauma head-on or moving beyond the trauma and focusing on the future. Emerging research suggests that the greatest healing may result from the ability to adaptively use both (i.e., coping flexibility). The current study sought to examine the psychometric properties of a self-report scale of coping flexibility: the Perceived Ability to Cope With Trauma (PACT) Scale. Method Participants included 322 undergraduate students enrolled in an introductory psychology course at a large Midwestern university. Analyses used the PACT's 2 scales, Trauma Focus and Forward Focus, as well as its flexibility score that is derived from these scales. Confirmatory factor analysis of the PACT was performed in Mplus. Results The PACT scales demonstrated high internal consistency and convergent validity with measures of experiential avoidance, distress tolerance, self-compassion, perceived stress, and PTSD symptoms. Discriminant validity was demonstrated by nonsignificant relations with fight and flight responding. All 3 PACT scores demonstrated significant relations with PTSD symptom clusters. The 2-factor model of the PACT demonstrated good fit after using item parceling. Conclusion Overall, the current analyses support and replicate the psychometric properties and construct validity of the PACT as a measure of adaptive trauma-related coping. Further, the PACT scales are significantly negatively related to PTSD symptom clusters, suggesting that the greater one's perceived ability to use Trauma Focus and Forward Focus skills flexibly, the less severe he or she will experience symptoms of reexperiencing, avoidance/numbing, and hyperarousal. Future applications are discussed. (PsycINFO Database Record

Preliminary evidence suggests that high emotional reactivity, in conjunction with maladaptive self-regulatory processes, increases one's vulnerability to develop psychopathology. In the present study, associations between behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivity, experiential avoidance (EA) and trauma-related outcomes (i.e., posttraumatic stress symptoms [PTSS]) were examined in a sample (N=851) of female college students who had experienced at least one traumatic event. Positive associations were observed between BIS sensitivity, EA, and PTSS. In addition, EA moderated the relationship between BIS sensitivity and PTSS, with participants high in BIS sensitivity and high in EA reporting significantly more PTSS than participants high in BIS sensitivity and low in EA. No association was observed between BIS sensitivity and PTSS for participants low in EA. These findings suggest that an unwillingness to experience unwanted private events, in conjunction with increased BIS sensitivity, contributes to PTSS severity. Further, there was a positive association and a negative association found between PTSS and BAS-Drive and BAS-Reward Responsiveness, respectively. A marginally significant EA×BAS-Fun Seeking interaction was also observed. Present findings suggests the importance of pursuing an etiological model of posttraumatic stress disorder in which neurobiological factors (i.e., BIS/BAS sensitivity) and self-regulatory processes (i.e., EA) interact to produce psychopathology.

The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance, and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78-.88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates, that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r=.97) but with better psychometric consistency.

The present study examined reactions to an experimental-based trauma study in a sample (N = 58) of women recently exposed to a campus shooting. Assessed participant characteristics included posttraumatic stress, depression, and anxiety symptoms, as well as physical exposure to the shooting. Participant reactions were assessed using a multimethod approach, including indices of subjective (self-report) and objective (heart rate, skin conductance, and cortisol) distress. Complementing prior studies, the assessed psychological symptoms tended to share significant correlations with subjective distress. However, among the psychological symptoms, only posttraumatic stress symptoms uniquely predicted subjective distress in regression analyses. Moreover, none of the assessed participant characteristics shared significant correlations with objective distress. Finally, a clear majority (85%) of participants reported they would participate in the study again. Points of convergence and divergence with prior studies are discussed.

Peritraumatic dissociation (PD) and experiential avoidance (EA) have been implicated in the etiology of posttraumatic stress symptomatology (PTSS); however, the function of these two factors in the onset and maintenance of PTSS following a potentially traumatic event is unclear. The temporal relationships between EA, PD, and the four clusters of PTSS proposed by the Simms/Watson dysphoria model (Simms, Watson, & Doebbeling, 2002) were examined in a three-wave prospective investigation of 532 undergraduate women participating in an ongoing longitudinal study at the time of a campus shooting. Path analyses indicated that pre-shooting EA predicted greater PD, intrusions, and dysphoria symptoms approximately one month post-shooting. PD was associated with increased symptomatology across all four clusters one-month post-shooting, while one-month post-shooting EA was associated with higher dysphoria and hyperarousal symptoms eight months post-shooting. PD had a significant indirect effect on all four PTSS clusters eight months post-shooting via one-month post-shooting symptom reports. The results suggest that both EA and PD show unique influences as risk factors for PTSS following a potentially traumatic event.

Conservation of resources (COR) theory has proven a useful framework for understanding posttrauma adjustment. A key tenet of this theory is the centrality of resource loss in determining adjustment. However, COR theory research has often been limited by retrospective research design, a focus on material loss (e.g., one’s home), and a lack of attention to other adjustment predictors. This study examined whether psychosocial resource loss prospectively predicted PTSD symptomatology both immediately and 8 months following a campus shooting in a sample of college women (n = 691). Results supported that resource loss predicted symptomatology, even after controlling for other predictors, including prior trauma, psychological distress, initial PTSD symptomatology, and shooting exposure. Implications of the results for research and intervention following mass trauma are discussed.

Using data from a biracial community sample of adolescents, the present study examined trajectories of alcohol use and abuse over a 15-year period, from adolescence into young adulthood, as well as the extent to which these trajectories were differentially predicted by coping and enhancement motives for alcohol use among the 2 groups. Coping and enhancement motivations (M. L. Cooper, 1994) refer to the strategic use of alcohol to regulate negative and positive emotions, respectively. Results showed that Black and White youth follow distinct alcohol trajectories from adolescence into young adulthood and that these trajectories are differentially rooted in the regulation of negative and positive emotions. Among Black drinkers, coping motives assessed in adolescence more strongly forecast differences in alcohol involvement into their early 30s, whereas enhancement motives more strongly forecast differences among White drinkers. Results of the present study suggest that different models may be needed to account for drinking behavior among Blacks and Whites and that different approaches may prove maximally effective in reducing heavy or problem drinking among the 2 groups.

Research suggests that racial and ethnic minorities are more likely to attrit from longitudinal trauma studies than non-Hispanic Whites. Yet, little is known about how the loss of minority participants influences longitudinal findings as well as internal and external validity of study findings. Thus, the present study examined the effects of race/ethnicity on attrition in a longitudinal trauma study of women (minority = 223, non-Hispanic White or majority = 459) exposed to a campus shooting. Survival analyses were used to compare the attrition rates of minority participants to majority participants and assess the extent to which race/ethnicity, among other variables, predicted attrition. Minority participants were more likely to attrit than majority participants, hazard ratio (HR) = 0.69, 95% CI [0.48, 0.99], even after adjusting for study variables. A main effect was also found for age, HR = 1.06, 95% CI [1.01, 1.12]. Race/ethnicity did not interact with other study variables to influence attrition. The findings underscored the importance of assessing the effects of attrition on longitudinal findings and external validity.

Critiques of self-report indices of emotion regulation suggest that its measurement is in need of more critical investigation. The current study examined the factor structure of emotion regulation as informed by Gross' (1998a) Process Model: Situation Selection, Attentional Deployment, Cognitive Change, and Response Modulation.A sample of 553 participants was recruited using Amazon's Mechanical Turk (M(age) = 37.12, SD = 13.66; n = 352 female). Confirmatory factor analysis with maximum likelihood estimation was performed in Mplus.A four-factor model of emotion regulation demonstrated poor fit. An alternative five-factor model fit the data well: CFI = .94, TLI = .93, RMSEA = .07.Emotion regulation may be better conceptualized as a combination of specific strategy use and a broader construct, called "emotional distancing" (a trait-like disposition towards emotions). Further research is required to determine if the observed five-factor model can be replicated in more diverse samples.

Increased risk of adult sexual assault (ASA) among women who experienced child sexual abuse (CSA) is well established. The strategies these women use to reduce negative affect secondary to CSA, such as sexual contact, may mediate the link between CSA and later ASA. Two waves of data from a racially diverse sample (i.e., 46% Black, 46.1% White, 7.9% other) of community women (N = 776) were analyzed using structural equation modeling. A history of CSA was associated with a twofold increase in the likelihood of experiencing ASA between the two measurement occasions (approximately 6 years). Psychological distress (i.e., depression, anxiety) and use of sex to reduce negative affect partially mediated the relation between CSA and prospective ASA. Implications for the treatment of CSA and prevention of sexual assault are discussed.

Emotion regulation (ER) has been identified as a critical factor in the development and maintenance of posttraumatic stress symptoms (PTS; Bardeen, Kumpula, & Orcutt, 2013 [Journal of Anxiety Disorders, 27, 188-196]; Marx & Sloan, 2005 [Behaviour Research and Therapy, 43, 569-583]; Nightingale & Williams, 2000 [British Journal of Clinical Psychology, 39, 243-254]). The current meta-analysis aimed to provide a thorough, quantitative examination of the associations between PTS and several aspects of ER. A search of the PsychINFO database resulted in 2557 titles, of which 57 met full inclusion criteria (the cross-sectional association between PTS symptoms and ER was reported, participants were 18 years or older, the article was written in English, and sufficient information was reported to calculate effect sizes). From the 57 studies that were included, 74 effect sizes were obtained. All studies were independently coded by two of the study authors for the following: citation, sample type, total N size (and group n's if applicable), mean age of participants, type of traumatic event, study design, PTS measure(s), ER measure(s), and effect size information. Eight random effects models were conducted: seven for individual ER strategies (e.g., rumination) and one for general emotion dysregulation. The largest effects were observed for general emotion dysregulation (r = 0.53; k = 13), rumination (r = 0.51; k = 5), thought suppression (r = 0.47; k = 13), and experiential avoidance (r = 0.40; k = 20). Medium effects were observed for expressive suppression (r = 0.29; k = 3) and worry (r = 0.28; k = 6). Significant effects were not observed for acceptance or reappraisal. Moderator analyses (sample and trauma type) were conducted for general emotion dysregulation, experiential avoidance, and thought suppression; no significant differences were observed. Findings from the current analysis suggest that several aspects of ER are associated with PTS symptoms across a variety of samples. Additionally, the current study highlights a number of limitations in the existing ER and PTS symptom literature.

In a sample with known levels of preshooting posttraumatic stress (PTS) symptoms, we examined the impact of a campus mass shooting on trajectories of PTS in the 31 months following the shooting using latent growth mixture modeling. Female students completed 7 waves of a longitudinal study (sample sizes ranged from 812 to 559). We identified 4 distinct trajectories (n = 660): (a) minimal impact-resilience (60.9%), (b) high impact-recovery (29.1%), (c) moderate impact-moderate symptoms (8.2%), and (d) chronic dysfunction (1.8%). Individuals in each trajectory class remained at or returned to preshooting levels of PTS approximately 6 months postshooting. The minimal impact-resilience class reported less prior trauma exposure (η(2) = .13), less shooting exposure (η(2) = .07), and greater emotion regulation skills than all other classes (η(2).30). The chronic dysfunction class endorsed higher rates of experiential avoidance prior to the shooting than the minimal-impact resilient and high impact-recovery classes (η(2) = .15), as well as greater shooting exposure than the high impact-recovery class (η(2) = .07). Findings suggest that preshooting functioning and emotion regulation distinguish between those who experience prolonged distress following mass violence and those who gradually recover.

Research suggests that adverse events in childhood, such as childhood physical, sexual, and emotional abuse, confer risk for later sexual assault. Psychological distress, coping strategies, and sexual behavior may help explain the path from childhood abuse to revictimization. The present study explored how the use of sex to regulate negative affect (SRNA) operates independently, and in combination with other psychosocial factors to increase college women's (N = 541) risk of experiencing prospective adult sexual assault (ASA). Sequential multiple mediator models in Mplus were used to assess the effect of three different forms of childhood abuse on prospective ASA, both independently and while controlling for other forms of childhood abuse. The indirect effect of adolescent sexual assault (AdolSA), depressive symptoms, SRNA, and participants’ response to a sex-related vignette was tested using bias-corrected bootstrapping. In the full path model, childhood emotional abuse and AdolSA predicted ASA, while childhood physical and sexual abuse were directly associated with AdolSA, but not ASA. Additionally, depressive symptoms and participants’ estimate of their likely behavior in a sex-related vignette directly predicted prospective ASA. Results using bootstrapping revealed that a history of childhood abuse predicted prospective ASA via diverse direct and indirect paths, as well as through a similar multiple mediator path. Overall, findings suggest that a combination of affective, coping, and sexual expectancy factors contribute to risk for revictimization in adult survivors of childhood abuse. Future research directions and targets for risk-reduction programming are discussed.

This study examined the influence of closed-circuit television (CCTV) on jurors' abilities to detect deception in children's testimony. Children ages 7-9 individually played games and made a video movie with a male confederate. In the guilty condition, stickers were placed on exposed body parts (i.e., the child's arm, toes, and bellybutton). In the not-guilty and deception conditions, stickers were placed on the child's clothing rather than on bare skin. Approximately 3 weeks later, mock jurors recruited from the community viewed child participants testify either in a traditional courtroom setting or via one-way CCTV. The mock jurors responded to questions about the child witness and the defendant as well as deliberated to reach a verdict. Children in the deception condition were asked to testify as if the stickers had been placed on exposed body parts rather than on their clothing. Predeliberation, jurors were less likely to convict when a child testified in the deception condition as opposed to the guilty condition. These differences disappeared following deliberation. There was no support for the notion that jurors reach the truth better when children testify in open court versus via CCTV. Implications for jurors' abilities to reach the truth are discussed.

Objective: The present study examined the links between alcohol use and condom use, and the nature of the sexual relationship in which these behaviors occurred, and tested the notion that partner type suppresses the negative, direct effects of alcohol use on condom use. Method: Data were collected as part of face-to-face interviews conducted with 1,417 (54% female) randomly selected young adults (aged 18-25 years) who had had sex in the past 6 months. Results: Using within-subjects analytic procedures, results showed that both drinking and condom use were more common with casual than with serious sexual partners, as expected. Moreover, consistent with the suppression hypothesis, the relationship between alcohol use and condom use became significant and negative only after controlling for partner type. Conclusions: These findings suggest that the interrelationships among partner type, alcohol use and condom use are complex and that the processes linking each pair of variables are best understood as part of...

A strong positive association between emotion regulation difficulties (ERD) and posttraumatic stress symptoms (PTSS) has been consistently evidenced in cross-sectional research. However, a lack of prospective research has limited hypotheses regarding the temporal relationship between trauma exposure, ERD, and PTSS. The present prospective study investigated the role of pre-trauma difficulties with emotion regulation in the development of PTSS following exposure to a potentially traumatic event. Between Time 1 (T1) and Time 2 (T2), a mass shooting occurred at the participants'(n = 691) university campus. ERD and PTSS were assessed prior to the shooting (T1), in the acute aftermath of the shooting (T2), and approximately eight months later (T3). Using a cross-lagged panel design, ERD was found to prospectively predict PTSS from T1 to T2 and T2 to T3. Additionally, PTSS prospectively predicted ERD from T1 to T2. However, T2 PTSS failed to predict T3 PTSS. Results indicate that ERD and PTSS are reciprocally influential from pre- to post-shooting. Further, results suggest that emotion dysregulation in the aftermath of a potentially traumatic event influences one's ability to recover from PTSS over time, even after accounting for the effects of existing symptomatology. To examine the specificity of temporal relations between ERD and PTSS a second cross-lagged panel design, in which a general distress construct was substituted for PTSS, was conducted. Results of this analysis, as well as conceptual and clinical implications, will be discussed.

Attentional threat bias (ATB) has been suggested as one factor leading to maintenance and exacerbation of posttraumatic stress symptoms (PTSS). In the present study, attentional processes (i.e., facilitated engagement, difficulty disengaging) underlying the association between ATB and PTSS were examined. Additionally, attentional control (AC) was examined as a moderator of this relationship. Participants (N=97) completed a dot-probe task with two levels of stimulus-onset asynchrony (SOA: 150 and 500ms). Higher PTSS were associated with ATB when SOA was longer (i.e., 500ms), suggesting difficulty disengaging from threat stimuli. AC moderated the relationship between PTSS and ATB when SOA was shorter (i.e., 150ms), with participants high in PTSS and high in AC having disengaged and shifted attention from threat stimuli using top-down AC when the emotional valence of threat stimuli was less salient (i.e., shorter presentation duration). Findings implicate AC as a buffering mechanism against prolonged attentional engagement with threat-related stimuli among those with high PTSS. Current PTSD interventions may benefit from incorporating attention-based components.

The purpose of this cross-sectional study was to understand the prevalence and severity of health-related sequelae of traumatic exposure in a nonpsychiatric, outpatient sample. Self-report surveys were completed by patients seeking outpatient medical (n = 123) and dental care (n = 125) at a large, urban academic medical center. Results suggested that trauma exposure was associated with a decrease in perceptions of overall health and an increase in pain interference at work. Contrary to prediction, a history of interpersonal trauma was associated with less physical and emotional interference with social activities. A history of trauma exposure was associated with an increase in time elapsed since last medical visit. Depression and anxiety did not mediate the relationship between trauma history and medical care. Based on these results, clinical and research implications in relation to the health effects of trauma are discussed. The results suggest that routine screening for traumatic events may be important, particularly when providers have long-term relationships with patients.

The frequency, severity, and reciprocity of female-perpetrated intimate partner violence and its consequences (i. e., injuries) were investigated in a college sample of women (N = 457). Participants were classified into one of the following four groups on the basis of selfreported physical assault perpetration and victimization against their relationship partners: nonviolent, perpetrator-only, victim-only, and bidirectionally violent. Results showed that females in the bidirectionally violent group had a reportedly higher occurrence (although not always statistically significant) of perpetration and victimization than those in the perpetrator-only and victim-only groups. Additionally, a similar degree of reciprocity was indicated by females in bidirectionally violent relationships in terms of violence severity and the occurrence of injury. Adult romantic attachment style was also examined among a subset of females (N = 328), and bidirectionally violent females were found to have the highest reported levels of attachment anxiety. Further, females high in attachment anxiety and low in attachment avoidance were more likely to report perpetrating violence than females high in both styles. Implications for prevention are discussed.

Relatively little is known about the course of PTSD symptoms over time following trauma exposure. Accordingly, this study utilized a specialized structural equation modeling approach, growth mixture modeling, to examine the trajectory of PTSD symptoms across three time points in a sample of Gulf War veterans (n at Time 1 = 2,949, n at Time 2 = 2,313, and n at Time 3 = 1,327). Results were most consistent with a two-group model suggesting that the course of PTSD symptoms following the Gulf War was best characterized by two distinct growth curves: (1) low levels of PTSD symptoms with little increase over time and (2) higher levels of initial symptoms with a significant increase over time. Thus, it appears that response to Gulf War experiences is not homogeneous, and that a subset of individuals may experience relatively more PTSD symptoms over time. In addition, men, Whites, those reporting more education, and those reporting less combat exposure had a significantly higher probability of being classified into the less symptomatic group.

Longitudinal data from a representative sample of 1,978 Black and White adolescents were used to examine the role of personality in multiple risk or problem behaviors. Results indicate that covariation among diverse behaviors (educational underachievement, delinquent behavior, substance use, sexual behavior) can be adequately modeled by a single higher order factor, and that impulsivity and avoidance coping serve as generalized risk factors for involvement in these behaviors. Whereas none of the personality variables examined explained change in problem behaviors once established, avoidance coping prospectively predicted involvement among a subgroup of adolescents with little or no prior involvement. Results suggest that dysfunctional styles of regulating emotions and emotionally driven behaviors are core features of risky or problem behaviors during adolescence.

Trauma exposure has been associated with increased risk of exposure to additional traumatic events. Reactions to trauma exposure, specifically PTSD symptomatology, may mediate the link between trauma exposure and later traumatic events. Data from a longitudinal sample of Gulf War veterans (N = 2,949) were analyzed using a series of regression models. Higher levels of combat exposure were related to increased reports of PTSD symptomatology immediately upon return as well as increased reports of traumatic events in the 2 years following the Gulf War. PTSD symptomatology partially mediated the link between combat exposure and later trauma. Symptom clusters were also analyzed separately as potential mediators. Implications for the treatment of PTSD and prevention of exposure to multiple traumas are discussed.