Person: Robinaugh, Donald
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Robinaugh
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Donald
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Robinaugh, Donald
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Publication Posttraumatic Distress Symptoms and Their Response to Treatment in Adults With Prolonged Grief Disorder(Physicians Postgraduate Press, Inc, 2021-04-20) Na, Peter; Adhikari, Samrachana; Szuhany, Kristin L.; Chen, Alan Z.; Suzuki, Rebecca R.; Malgaroli, Matteo; Robinaugh, Donald; Bui, Eric; Mauro, Christine; Skritskaya, Natalia A.; Lebowitz, Barry D.; Zisook, Sidney; Reynolds, Charles F.; Shear, M; Simon, NaomiObjective: Posttraumatic stress disorder and Prolonged Grief Disorder (PGD) arise following major life stressors, and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of post-traumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. Methods: A randomized controlled trial of 395 adults with PGD (defined as >30 on the Inventory of Complicated Grief plus confirmation on structured clinical interview) randomized participants to complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. We examined the presence of PTSS (Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed effects regression, and examined the role of violent compared to non-violent deaths (loss type). Results: High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (p<0.01). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR=2.71, 95%CI [1.13-2.17], p=0.026) and continuous (p<0.001; effect size d=0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis OR=2.84, 95%CI [1.20-6.70], p=0.017; continuous p=0.053; d=0.25). In contrast, citalopram did not differ from placebo and CGT plus citalopram did not differ from CGT plus placebo. Conclusion: Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and non-violent death, and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not.Publication Anxiety Sensitivity in Bereaved Adults With and Without Complicated Grief(Ovid Technologies (Wolters Kluwer Health), 2014) Robinaugh, Donald; McNally, Richard; Leblanc, Nicole; Pentel, Kimberly Z.; Schwarz, Noah R.; Shah, Riva M.; Nadal-Vicens, Mireya; Moore, Cynthia; Marques, Luana; Bui, Eric; Simon, Naomi MicheleComplicated grief (CG) is a bereavement-specific syndrome chiefly characterized by symptoms of persistent separation distress. Physiological reactivity to reminders of the loss and repeated acute pangs or waves of severe anxiety and psychological pain are prominent features of CG. Fear of this grief-related physiological arousal may contribute to CG by increasing the distress associated with grief reactions and increasing the likelihood of maladaptive coping strategies and grief-related avoidance. Here, we examined anxiety sensitivity (AS; i.e., the fear of anxiety-related sensations) in two studies of bereaved adults with and without CG. In both studies, bereaved adults with CG exhibited elevated AS relative to those without CG. In study 2, AS was positively associated with CG symptom severity among those with CG. These findings are consistent with the possibility that AS contributes to the development or maintenance of CG symptoms.Publication Mental Disorders as Causal Systems(SAGE Publications, 2014) McNally, Richard; Robinaugh, Donald; Wu, Gwyneth Winnie Y; Wang, Li; Deserno, M. K.; Borsboom, D.Debates about posttraumatic stress disorder (PTSD) often turn on whether it is a timeless, cross-culturally valid natural phenomenon or a socially constructed idiom of distress. Most clinicians seem to favor the first view, differing only in whether they conceptualize PTSD as a discrete category or the upper end of a dimension of stress responsiveness. Yet both categorical and dimensional construals presuppose that PTSD symptoms are fallible indicators reflective of an underlying, latent variable. This presupposition has governed psychopathology research for decades, but it rests on problematic psychometric premises. In this article, we review an alternative, network perspective for conceptualizing mental disorders as causal systems of interacting symptoms, and we illustrate this perspective via analyses of PTSD symptoms reported by survivors of the Wenchuan earthquake in China. Finally, we foreshadow emerging computational methods that may disclose the causal structure of mental disorders.Publication Examining Cognitive Impairments in Bereaved Adults With and Without Complicated Grief(2015-08-10) Robinaugh, Donald; McNally, Richard J.; Nock, Matthew K.; Schacter, Daniel L.; Simon, Naomi M.Grief is a syndrome of cognitions, emotions, and behaviors that commonly arise together following the death of a loved one. It includes intense pangs of emotional pain, yearning for the deceased, emotional numbness, subjective difficulty imagining the future without the deceased, and preoccupation with thoughts related to the death and the deceased. In the initial months following loss, the majority of bereaved adults will experience some or even many elements of this syndrome. For most, the frequency and severity of these elements diminishes over time. However, for some, grief persists for years after the loss; a condition known as complicated grief (CG). These distinct grief trajectories raise a critically important question for grief research: why does grief persist in some individuals, but not others? In this dissertation, I aimed to take an initial step toward answering this question. I first review recent advances in our understanding of the nature of CG and discuss the implications of these advances for research examining the etiology of CG. Most notably, I review how vulnerability factors that render bereaved adults susceptible to experiencing specific elements of the CG syndrome may contribute to the development or maintenance of CG. I then present three studies in which I examined cognitive impairments that may act as vulnerability factors for the core cognitive elements of CG and, thereby, may contribute to the broader CG syndrome. In Paper 1, I examined the ability to resist distracter information and the ability to resist proactive interference; two types of cognitive inhibition that, if impaired, may render bereaved adults vulnerable to experiencing intrusive grief-related cognitions and, thus, the broader CG syndrome. Contrary to my hypotheses, I found no evidence that bereaved adults with CG exhibit deficits in either type of cognitive inhibition for either emotional or non-emotional information relative to a bereaved comparison group without CG. In Paper 2, I examined another type of cognitive control: the ability to shift between mental representations. Contrary to my hypotheses, bereaved adults with CG did not exhibit deficits in cognitive set shifting for either emotional or non-emotional information. In Paper 3, I examined the ability to engage in episodic simulation of novel future events. Consistent with my hypotheses, bereaved adults with CG produced event simulations with fewer episodic details, less perceptual richness, less emotion/thought content, and less episodic richness than did the bereaved comparison group. Together, these studies provide a small step toward identifying cognitive vulnerabilities that may contribute to the development or maintenance of CG. Papers 1 and 2 suggest that general deficits in cognitive control are unlikely to feature prominently in the etiology of CG. Accordingly, in future studies, it will be important for researchers to examine alternative factors that may contribute to the preoccupying grief-related cognitions observed in CG, including cognitive control for more specific types of information than were assessed in this study (e.g., attachment- or grief-related information) and higher-order cognitive variables such as perceived explicability of the loss. Paper 3 providers further evidence that prospection is impaired in bereaved adults with CG and identifies impaired constructive episodic simulation of novel future events as a potential cognitive vulnerability that may contribute to the etiology of the broader CG syndrome.Publication Network analysis of persistent complex bereavement disorder in conjugally bereaved adults.(American Psychological Association (APA), 2014) Robinaugh, Donald; Leblanc, Nicole; Vuletich, Heidi A.; McNally, RichardPersistent complex bereavement disorder (PCBD) is a bereavement-specific syndrome characterized by prolonged and impairing grief. Most research on this syndrome rests on the traditional latent variable model, whereby symptoms reflect an underlying entity. The network (or causal system) approach offers an alternative framework for understanding PCBD that does not suffer from limitations inherent in the latent entity approach. The network approach to psychopathology conceptualizes the relation between symptoms and disorder as mereological, not reflective. That is, symptoms do not reflect an inferred, unobservable category or dimension, but rather are themselves constitutive of the disorder. Accordingly, we propose that PCBD constitutes a causal system of mutually reinforcing symptoms that arise following the death of a loved one and settle into a pathological equilibrium. In this study, we used data from the Changing Lives of Older Couples database to identify symptoms central to PCBD, to distinguish the PCBD network from an overlapping but distinct network of depression symptoms, and to examine how previously identified risk factors may contribute to the maintenance or development of PCBD. Together, these findings provide an important first step toward understanding the nature and etiology of the PCBD network.Publication A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse(Informa UK Limited, 2017) McNally, Richard; Heeren, Alexandre; Robinaugh, DonaldBackground: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms. Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179). Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms. Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA. Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.Publication Risk Factors and Posttraumatic Stress Disorder: Are They Especially Predictive Following Exposure to Less Severe Stressors?(Wiley-Blackwell, 2011) McNally, Richard; Robinaugh, DonaldBackground: The diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic stressor, as defined by Criterion A in the DSM criteria for PTSD. Yet, over the course of successive revisions of the diagnostic manual, the range of qualifying stressors has expanded considerably (e.g., watching terrorist attacks on television). Moreover, stressors that fall short of qualifying for even an expanded Criterion A can produce apparent PTSD. Taken together, these findings imply that people who do satisfy symptomatic criteria for PTSD following exposure to less severe stressors carry a heavy burden of risk factors. Method: To test this hypothesis, we examined whether the association between the risk factor of lower intelligence and more severe PTSD and depression symptoms would be greater among women reporting less severe CSA (n = 15) relative to women who reported moderate (n = 54) or high (n = 31) severity CSA. Results: The evidence was consistent with this hypothesis for subjects in the low and moderate severity groups, but less so for those in the high severity group. Conclusions: Lower intelligence was a more potent risk factor for posttraumatic distress among people exposed to less severe relative to moderately severe stressors.Publication Trauma Centrality and PTSD Symptom Severity in Adult Survivors of Childhood Sexual Abuse(Wiley-Blackwell, 2011) Robinaugh, Donald; McNally, RichardTheorists have posited that regarding a trauma as central to one's identity leads to greater posttraumatic stress disorder (PTSD) symptom severity. To test this hypothesis, we administered the Centrality of Events Scale (CES) to women reporting a history of childhood sexual abuse (N = 102). The CES scores were correlated with PTSD symptom severity, depression severity, and self-esteem. In addition, we conducted a principal component analysis (PCA) to evaluate factors underlying the CES. The PCA yielded 3 factors reflecting (a) the centrality and integration of the trauma, (b) whether the event is regarded as a turning point in one's life story, and (c) whether the event is a reference point for expectations about the future. Each factor was associated with PTSD symptom severity.Publication A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse(Taylor & Francis, 2017) McNally, Richard; Heeren, Alexandre; Robinaugh, DonaldABSTRACT Background: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms. Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179). Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms. Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA. Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.