School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.
NHS Lothian, Rivers Centre for Traumatic Stress, Royal Edinburgh Hospital, Edinburgh, UK.
Clin Psychol Psychother. 2019 Jan;26(1):94-104. doi: 10.1002/cpp.2333. Epub 2018 Oct 16.
Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post-traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma-related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self-harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self-harm and/or self-harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post-traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma-related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma-related emotions on PTSD severity. Three trauma-related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self-harm and via self-harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self-harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self-harm might enable the reduction of PTSD among CSA survivors.
情绪调节（ER）困难已被确定为治疗儿童期性虐待（CSA）幸存者创伤后应激障碍（PTSD）症状的临床干预的重要目标。然而，关于使用特定策略来调节创伤后特定情绪的研究有限。本研究旨在通过两个中介变量（去人格化和自残）来探讨四种与创伤相关的情绪（愤怒、悲伤、厌恶和恐惧）对 PTSD 严重程度的间接影响。特别是，我们测试了这两个假设的中介变量是否依次运作，即去人格化先于自残，或者自残先于去人格化。一个主要由 CSA 幸存者组成的女性临床样本（N=109）完成了情绪体验、ER 和创伤后应激的测量。进行了双变量和序列中介分析，以测试与创伤相关的情绪对 PTSD 严重程度的直接和间接影响。序列中介分析表明，所有与创伤相关的情绪对 PTSD 严重程度都有显著的总效应。三种与创伤相关的情绪（悲伤、厌恶和恐惧）通过去人格化和自残以及自残和去人格化与 PTSD 严重程度间接相关。结果表明，调节悲伤、厌恶和恐惧情绪的困难可能导致更严重的去人格化和自残作为应对策略，进而导致 PTSD 更严重。中介的顺序在这些途径中并不重要。总体而言，我们的研究结果表明，针对去人格化和自残进行治疗可能有助于减少 CSA 幸存者的 PTSD。
