Cross-Lagged Analyses of Anger and PTSD Symptoms Among Veterans in Treatment

Sean Cowlishaw; Olivia Metcalf; Jonathon Little; Mark Hinton; David Forbes; Tracey Varker; James Agathos; Richard A. Bryant; Alexander C. McFarlane; Malcolm Hopwood; Andrea J. Phelps; Alexandra Howard; John Cooper; Lisa Dell; Meaghan L. O’Donnell

doi:10.1037/tra0001084

Cross-Lagged Analyses of Anger and PTSD Symptoms Among Veterans in Treatment

Sean Cowlishaw, Olivia Metcalf, Jonathon Little, Mark Hinton, David Forbes, Tracey Varker, James Agathos, Richard A. Bryant, Alexander C. McFarlane, Malcolm Hopwood, Andrea J. Phelps, Alexandra Howard, John Cooper, Lisa Dell, Meaghan L. O’Donnell

Research output: Contribution to journal › Article › Research › peer-review

5 Citations (Scopus)

Abstract

Objective: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. Method: Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month followup. Bidirectional influences were assessed using cross-lagged panel analyses. Results: The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. Conclusions: Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD.

Original language	English
Pages (from-to)	336-345
Number of pages	10
Journal	Psychological Trauma: Theory, Research, Practice, and Policy
Volume	14
Issue number	2
DOIs	https://doi.org/10.1037/tra0001084
Publication status	Published - Feb 2022
Externally published	Yes

Keywords

Anger
Cross-lagged analyses
Ptsd
Treatment
Veteran

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1037/tra0001084

Cite this

Cowlishaw, S., Metcalf, O., Little, J., Hinton, M., Forbes, D., Varker, T., Agathos, J., Bryant, R. A., McFarlane, A. C., Hopwood, M., Phelps, A. J., Howard, A., Cooper, J., Dell, L., & O’Donnell, M. L. (2022). Cross-Lagged Analyses of Anger and PTSD Symptoms Among Veterans in Treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 14(2), 336-345. https://doi.org/10.1037/tra0001084

@article{c2acb50eefd3432f996b43789a152c6d,

title = "Cross-Lagged Analyses of Anger and PTSD Symptoms Among Veterans in Treatment",

abstract = "Objective: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. Method: Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month followup. Bidirectional influences were assessed using cross-lagged panel analyses. Results: The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. Conclusions: Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD.",

keywords = "Anger, Cross-lagged analyses, Ptsd, Treatment, Veteran",

author = "Sean Cowlishaw and Olivia Metcalf and Jonathon Little and Mark Hinton and David Forbes and Tracey Varker and James Agathos and Bryant, {Richard A.} and McFarlane, {Alexander C.} and Malcolm Hopwood and Phelps, {Andrea J.} and Alexandra Howard and John Cooper and Lisa Dell and O{\textquoteright}Donnell, {Meaghan L.}",

note = "Funding Information: This work was supported by Centenary of Anzac Center, a Department of Veterans' Affairs funded initiative of Phoenix Australia. The views expressed in this report do not necessarily represent the views of the Minister for Veterans{\textquoteright} Affairs or the Department of Veterans{\textquoteright} Affairs. The Commonwealth does not give any warranty nor accept any liability in relation to the contents of this work. The funder had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2021 American Psychological Association",

year = "2022",

month = feb,

doi = "10.1037/tra0001084",

language = "English",

volume = "14",

pages = "336--345",

journal = "Psychological Trauma: Theory, Research, Practice, and Policy",

issn = "1942-9681",

publisher = "American Psychological Association",

number = "2",

}

Cowlishaw, S, Metcalf, O, Little, J, Hinton, M, Forbes, D, Varker, T, Agathos, J, Bryant, RA, McFarlane, AC, Hopwood, M, Phelps, AJ, Howard, A, Cooper, J, Dell, L & O’Donnell, ML 2022, 'Cross-Lagged Analyses of Anger and PTSD Symptoms Among Veterans in Treatment', Psychological Trauma: Theory, Research, Practice, and Policy, vol. 14, no. 2, pp. 336-345. https://doi.org/10.1037/tra0001084

TY - JOUR

T1 - Cross-Lagged Analyses of Anger and PTSD Symptoms Among Veterans in Treatment

AU - Cowlishaw, Sean

AU - Metcalf, Olivia

AU - Little, Jonathon

AU - Hinton, Mark

AU - Forbes, David

AU - Varker, Tracey

AU - Agathos, James

AU - Bryant, Richard A.

AU - McFarlane, Alexander C.

AU - Hopwood, Malcolm

AU - Phelps, Andrea J.

AU - Howard, Alexandra

AU - Cooper, John

AU - Dell, Lisa

AU - O’Donnell, Meaghan L.

N1 - Funding Information: This work was supported by Centenary of Anzac Center, a Department of Veterans' Affairs funded initiative of Phoenix Australia. The views expressed in this report do not necessarily represent the views of the Minister for Veterans’ Affairs or the Department of Veterans’ Affairs. The Commonwealth does not give any warranty nor accept any liability in relation to the contents of this work. The funder had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication. Publisher Copyright: © 2021 American Psychological Association

PY - 2022/2

Y1 - 2022/2

N2 - Objective: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. Method: Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month followup. Bidirectional influences were assessed using cross-lagged panel analyses. Results: The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. Conclusions: Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD.

AB - Objective: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. Method: Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month followup. Bidirectional influences were assessed using cross-lagged panel analyses. Results: The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. Conclusions: Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD.

KW - Anger

KW - Cross-lagged analyses

KW - Ptsd

KW - Treatment

KW - Veteran

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U2 - 10.1037/tra0001084

DO - 10.1037/tra0001084

M3 - Article

C2 - 34435811

AN - SCOPUS:85123879617

SN - 1942-9681

VL - 14

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EP - 345

JO - Psychological Trauma: Theory, Research, Practice, and Policy

JF - Psychological Trauma: Theory, Research, Practice, and Policy

IS - 2

ER -

Cross-Lagged Analyses of Anger and PTSD Symptoms Among Veterans in Treatment

Abstract

Keywords

UN SDGs

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