Changes in Anger, Anxiety Impact PTSD Symptom Severity

Clinician consideration of patient emotion during treatment may aid clinicians in addressing pathology of PTSD.

Following exposure to a neutral script, patients with a current posttraumatic stress disorder (PTSD) diagnosis had significantly higher anger lability compared with those without a PTSD diagnosis, according to the results of research published in the Journal of Anxiety Disorders. Anger, anxiety, and self-conscious emotional state had higher lability and synchrony among all participants following exposure to an individualized trauma script.

Researchers enrolled 157 patients from a residential treatment facility for substance use disorders who had experienced ≥1 criterion A traumatic event (eg, unexpected death of a loved one, sexual assault, assault with a weapon, or physical assault). PTSD was assessed by means of a clinician-administered PTSD scale (current PTSD, n=50; 31.8%). On different days, participants were exposed to either an individualized trauma script or a neutral script. Changes in anger, anxiety, and self-conscious emotional state over the course of the sessions were measured with the Positive and Negative Affect Schedule.

Following exposure to the trauma script, all participants reported significantly higher levels of anxiety, anger, and self-conscious emotional state compared with exposure to the neutral script, regardless of PTSD diagnosis (P <.001 for all). Compared with participants without PTSD, those with PTSD reported significantly more anxiety after the trauma script (P =.02) but not after the neutral script (P =.083). Similarly, participants with PTSD reported more anger after the trauma script (P <.001) and after the neutral script (P =.005).

Based on within-person lability scores, participants with PTSD reported significantly higher anger lability compared with those without PTSD following the neutral script (P =.046).

Related Articles

Regardless of PTSD status, synchrony was noted between each pair of emotions. Self-conscious emotional state covariation with anger and with anxiety was significantly increased following the trauma script compared with the neutral script.

The study authors concluded that the study results, “highlight the importance of assessing for and targeting anger in the treatment of PTSD pathology.” They continued to explain that the results, “suggest the importance of assessing mixed emotional experiences and the function of their component emotions. To this end, treatments aimed at increasing emotional clarity and awareness of the complexity of emotional responses to trauma cues may be particularly useful.”


Schoenleber M, Berghoff CR, Gratz KL, Tull MT. Emotional lability and affective synchrony in posttraumatic stress disorder pathology. J Anxiety Disord. 2017;53:68-75.