(PS11-B50) Psychiatric Symptom Contributions to Goal-directed Behavior Among Veterans with Comorbid Posttraumatic Stress Disorder and Severe Mental Illness

Introduction: Previous investigations suggest posttraumatic stress disorder (PTSD) is related to emotion regulation difficulties (Ehring & Quack, 2010), such as impulse-control problems, lack of emotional acceptance, and difficulties engaging in goal-directed behaviors when distressed (Tull et al., 2007). Emotion regulation difficulties demonstrate a reciprocal relationship with PTSD symptoms as well, such that as emotion regulation difficulties increase, so do PTSD symptoms (Weiss et al., 2019). This interaction between emotion regulation difficulties and PTSD symptoms may present a substantial obstacle to participation in treatment. Goal-directed behaviors relevant to psychotherapy include seeking treatment and attending scheduled sessions where, conceivably, the primary objective is to address presenting symptoms that compromise healthy functioning. While prior research establishes a positive association between emotion regulation difficulties and PTSD symptom severity, there is little evidence to describe the relationship for those with a comorbid severe mental illness (SMI). Additionally, the influence of symptom severity more broadly on goal-directed behavior among individuals with comorbid PTSD and SMI remains unclear.

Method: Considering high lifetime exposure to traumatic events in SMI populations, the present study sought to examine the contribution of posttraumatic stress symptom severity, psychiatric symptom severity, and depression symptom severity on difficulty engaging in goal directed behavior among a sample of Veterans (N = 53; 75.8% Male; 24.2% Female; 50.8% Black; 43.0% White). Participants were recruited from a PTSD specialty clinic in the southeastern United States as part of a separate treatment trial. Per this study, those who completed study-related assessments were included. A multiple regression analysis was conducted with posttraumatic stress symptom severity (PCL-5), psychiatric symptom severity (BPRS), and depression symptom severity (HAM-D) entered as predictor variables; goal-directed behavior (DERS) was entered as the outcome variable.

Results: Variance inflation factor and collinearity tolerance values (VIF less than 2.0, tolerance greater than .50) suggest orthogonality among all predictor variables within the model. The final multiple regression model was significant (F [3,49] = 17.77, p < .001; adjusted R2 = .492), accounting for 49.2% of the variance in goal-directed behavior. Posttraumatic stress symptoms (β = .239, p < .001) and psychiatric symptom severity (β = .116, p < .001) were significant predictors within the model, whereas depression symptoms (β = -.023, p = .815) were not.

Discussion: Results from this study suggest that broad psychiatric symptom severity accounts for a substantial proportion of variance within goal-directed behaviors. Goal-directed behaviors are an integral aspect of treatment, and as such, clinician awareness of symptom severity may be pivotal for treatment initiation, adherence, and retention among this population. Further, results may provide insight to intrinsic treatment barriers that may be addressed by interventions that target emotion regulation and goal-directed behaviors.