(PS2-22) Exploring the Effect of Anxiety Disorder Diagnosis and Experiencing a Trauma on Emotion Regulation Deficits

Background: Emotion regulation (ER) is related to the development and maintenance of anxiety disorders. ER deficits also are present following traumatic events, with sexual or physical assault specifically associated with poorer ER. Less is known about the interaction of anxiety and experience of traumatic events on ER deficits. We hypothesized that adults with an anxiety disorder who have experienced at least one lifetime trauma would evidence worse ER than those with an anxiety disorder but no traumatic event exposure, as well as healthy controls with or without trauma exposure. We also hypothesized reported exposure to past sexual or physical assault would be associated with worse ER than other trauma types amongst those with anxiety disorders.

Methods: Participants were 388 adults (63.9% female, mean age 28.9[11.64]), 77.1% with a primary anxiety disorder (generalized anxiety disorder n=160, social anxiety disorder n=127, panic disorder n=12) and 22.9% non-psychiatric controls (n=89) who completed a structured clinical interview and self-report measures for ER (Difficulties in Emotion Regulation Scale [DERS]), and trauma history (Trauma Event Questionnaire [TEQ]). At least one trauma (any lifetime TEQ trauma) was endorsed by 226 (58.2%) participants. Differences in DERS total score means were examined with analysis of variance (ANOVA) with Tukey post-hoc test across 4 groups: 1) anxiety + trauma; 2) anxiety + no trauma; 3) control + trauma; 4) control + no trauma. A similar ANOVA examined differences in DERS total across trauma types in those with an anxiety disorder ordered hierarchically: 1) any sexual/physical assault; 2) witnessing a trauma; 3) natural disaster; 4) other.

Results: DERS differed by anxiety and trauma (F[3, 384] = 72.23, p < .001); post-hoc tests showed significantly worse ER (all ps < .001) for the anxiety + trauma (M[SD] = 93.50[23.77], n=182) and the anxiety + no trauma groups (91.61[19.81], n=117) compared to the control + trauma (57.75[11.82], n=44) and the control + no trauma group (55.49[11.41], n=45). ER did not differ for the anxiety + trauma and the anxiety + no trauma groups (p = 0.86). For those with anxiety disorders and ≥1 trauma, DERS differed by trauma type (F[3, 173] = 7.49, p = .03). Those who experienced sexual/physical assault (99.83[21.99], n=58) had significantly worse ER compared to natural disaster (84.57[21.77], p =.038, n=23), but not the other groups: witnessing a trauma (88.86[22.76], p = .16, n=28), and other (93.56[24.08], p = .42, n=68).

Conclusions: While adults with anxiety disorders demonstrate ER deficits (vs. controls), contrary to hypotheses, trauma exposure was not associated with worse ER for those with anxiety disorders or controls. However, the subgroup of adults with anxiety disorders who experienced sexual or physical assault evidenced worse ER than those reporting other trauma types, suggesting ER may be an important treatment target for those with interpersonal trauma. Limitations include the retrospective, self-report, and lack of severity rating of traumatic events. Future research should include clinical assessment for type of traumatic event experienced to best determine risk factors for ER deficits.