Anxiety Sensitivity Moderates the Effect of Posttraumatic Stress Disorder Symptoms on Emotion Dysregulation among Trauma-Exposed Firefighters

Posttraumatic stress disorder (PTSD) symptoms are associated with significant emotion dysregulation, which in turn marks risk for greater symptom-related difficulties and psychiatric comorbidity. Individuals with PTSD symptoms who are high in anxiety sensitivity (AS; fear of anxiety and related sensations) may have particular difficulty managing negative affect, as they tend to perceive their trauma-related symptoms to be more threatening. The present study investigated the main and interactive effects of PTSD symptoms (PTSD Checklist for DSM-5) and AS (Anxiety Sensitivity Index-3) on emotion dysregulation (Difficulties in Emotion Regulation Scale-16) in a sample of 836 trauma-exposed firefighters (94.6% men; M-age = 38.5 years, SD = 8.5). Results of hierarchical linear regression models indicated that the main effects of PTSD symptom severity (beta = .353, p < .001) and AS (beta = .273, p < .001) were significantly positively associated with emotion dysregulation, accounting for 28.0% of variance. The interaction term accounted for an additional 2.0% of variance (beta = .157, p < .001). Post hoc probing of simple slopes revealed that the strength of the association between PTSD symptom severity and emotion regulation was more than twice as strong for individuals high, compared to low, in AS. Exploratory analyses regarding subscales of the Difficulties in Emotion Regulation Scale-16 (i.e., Clarity, Goals, Impulse, Strategies, and Non-Acceptance) were also conducted. PTSD symptoms were associated with greater emotion dysregulation for all DERS-16 subscales; AS was associated with greater emotion dysregulation for all subscales with the exception of DERS-16 Impulse. AS moderated the association between PTSD symptoms and DERS-16 Strategies and DERS-16 Non-acceptance. Specifically, greater PTSD symptoms were associated with less access to emotion regulation strategies and greater non-acceptance of emotions for those high, compared to low, in AS. These findings provide novel information regarding the ways in which PTSD symptoms, AS, and emotion dysregulation are interrelated in trauma-exposed, active-duty firefighters.