Healing trauma: Research links PTSD, emotion regulation and quality of life
We often talk about the coronavirus pandemic in terms of health or economic impacts: the numbers of cases and deaths, the persistence of long-haul COVID, lost jobs and toilet paper shortages.
But there is another crisis, too, that can linger even as cases fall in an increasingly vaccinated population. The pandemic is a type of mass trauma, explained Binghamton University doctoral candidate in psychology Craig Polizzi. And trauma can and does give rise to post-traumatic stress disorder (PTSD), and potentially problematic behaviors and a lower quality of life.
Recent research from Polizzi, fellow graduate student Damla Aksen and Distinguished Professor of Psychology Steven Jay Lynn provides insight into the impact PTSD has on emotional regulation and quality of life, and points to ways to improve both. Their article, "Quality of Life, Emotion Regulation Dissociation: Evaluating Unique Relations in an Undergraduate Sample and Probable PTSD Subsample," was published in a recent issue of the journal Psychological Trauma: Theory, Research, Practice and Policy.
Their research fills some of the gaps left by previous studies into PTSD, emotion regulation and quality of life. Previous studies mainly focused on older adults and individuals with medical problems, and tested emotion regulation strategies or difficulties separately; they also didn't account for important variables that may explain the relation between emotion regulation and quality of life. Polizzi, Aksen and Lynn instead take a more comprehensive approach and include such critical variables as dissociation, neuroticism and PTSD symptoms in addition to dimensions of emotion regulation.
Using questionnaires and personal narratives, the researchers identified participating college students who potentially met the diagnostic criteria for PTSD. The traumatic events these students experienced ranged from physical or sexual assault to car accidents, abuse, severe illness and witnessing suffering. The researchers then used a series of self-report surveys to measure difficulties in emotional regulation, positive and negative coping strategies and dissociative experiences with the participants.
It's eye-opening to see how much trauma college students—and the U.S. population in general—are exposed to, Polizzi acknowledged.
"The positive side to these statistics, though, is how remarkably resilient people can be following traumatic events, especially during this pandemic," he said.
What is quality of life?
"Quality of life" isn't an amorphous concept, although researchers can have different definitions, including improved function related to physical health and psychological well-being. It can actually be measured in many ways, such as through self-report surveys, physician ratings or direct observation, Polizzi explained.
In the study, the researchers relied on a broad definition informed by the World Health Organization (WHO), which defines quality of life as healthy functioning across mental processing, life activities, physical mobility, participating in society, self-care and social skills. In particular, they administered a questionnaire, the WHO Disability Assessment Schedule, based on the organization's definition of this concept.
Closely associated with quality of life is emotion regulation, or the ability to alter your emotional state to better cope with the situation at hand. People with enhanced emotion regulation tend to have greater psychological health, whereas problems in this area are associated with psychological difficulties, Polizzi explained.
During and following traumatic events, many people dissociate—or distance themselves from their emotions, body, mind and even personal identity—to escape overwhelming feelings such as shame, fear and anger. People who experience dissociation may lose focus, forget people and events, have out-of-body experiences or extreme daydreaming, and feel a sense of unreality and detachment from their immediate surroundings.
While some researchers have argued that dissociation is an emotion regulation strategy, it typically has negative effects, including interfering with emotional awareness, sense of self, social bonds and engagement in daily activities. In fact, it was surprising how strongly dissociation was related to quality of life, Polizzi acknowledged. Rather than just a part of other unhealthy emotion regulation strategies, it appears to play a disruptive role in daily activities and everyday behaviors.
Overall, their research suggests that decreased emotion regulation is related to a lower quality of life, although not necessarily a sole cause. People may experience a lowered quality of life for many reasons, one of which could be the inability to effectively regulate their emotions; conversely, the lack of psychological resources—for example, from stress, pain or physical health issues—could also limit a person's ability to emotionally regulate.
"These variables could exist in a vicious cycle, in which lack of emotion regulation contributes to lowering quality of life, which in turn reduces emotion regulation skills," said Polizzi, adding that further research is needed to confirm this idea.
On the plus side, emotion regulation is something that people can learn.
"Many techniques used in psychological treatments are designed to help individuals enhance their emotion regulation. For example, learning to accept and re-interpret emotions in realistic ways rather than avoiding emotions and blaming them on others can improve people's psychological functioning and their quality of life," Polizzi said.
Three main symptoms
In their research, Polizzi, Aksen and Lynn provide information that could refine the current evidence-based practices for treating PTSD by focusing on a trio of symptoms that have a strong impact on an individual's quality of life: namely, dissociation, impulsivity and blaming others.
Used as a coping strategy for negative emotions, impulsive behaviors can lead to physical injury, substance abuse and other health concerns, while dissociation may make it even more difficult for people with PTSD to be emotionally engaged, cope with stress, set goals and have a healthy sense of self. Individuals with PTSD also tend to mistrust others, which could lead to blame in interpersonal interactions and the further erosion of social bonds.
That doesn't mean, however, that trauma is a one-way street to a diminished life. Many individuals can learn how to successfully cope with such experiences, and treatment can lead to a greatly improved quality of life. For those diagnosed with PTSD, focusing on these three factors would be especially helpful during the later phases of treatment, when the individual has improved their coping skills and stability, Polizzi said.
If the pandemic's aftermath has you feeling not quite yourself, it might be helpful to take an honest look at how you're really feeling and the strategies—good and bad—that you're using to cope.
"People experiencing increased psychological stress during this pandemic may look to improve their quality of life by focusing on ways to enhance their emotion regulation skills via reducing dissociation, impulsivity and blaming others, such as increasing emotional engagement, planning goal-directed behaviors and fostering compassion toward others, respectively," Polizzi said.