PTSD Symptom Severity and Emotion Regulation Strategy Use During Trauma Cue Exposure Among Patients With Substance Use Disorders: Associations With Negative Affect, Craving, and Cortisol Reactivity

doi:10.1016/j.beth.2017.05.005

Behavior Therapy

Volume 49, Issue 1, January 2018, Pages 57-70

https://doi.org/10.1016/j.beth.2017.05.005 Get rights and content

Highlights

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Examined emotion regulation strategy use in substance dependent patients with PTSD.
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PTSD symptoms related to using more maladaptive and adaptive strategies.
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Maladaptive strategy use associated with more emotional reactivity in PTSD.
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Adaptive strategy use associated with less emotional reactivity in PTSD.

Abstract

The co-occurrence of posttraumatic stress disorder (PTSD) pathology with a substance use disorder (SUD) is associated with emotion regulation deficits. However, studies in this area generally rely on trait-based emotion regulation measures, and there is limited information on the relation of PTSD pathology to the use of specific emotion regulation strategies in response to trauma-related distress among SUD patients or the consequences of these strategies for trauma cue reactivity. This study examined the relation of PTSD symptom severity to the use of specific emotion regulation strategies during trauma cue exposure among trauma-exposed SUD patients, as well as the indirect relations of PTSD symptom severity to changes in negative affect, cravings, and cortisol levels pre- to posttrauma cue exposure through different emotion regulation strategies. Participants were 133 trauma-exposed SUD patients. Participants listened to a personalized trauma script and reported on emotion regulation strategies used during the script. Data on negative affect, cravings, and cortisol were collected pre- and postscript. PTSD symptom severity related positively to the use of more adaptive (e.g., distraction) and maladaptive (e.g., suppression) regulation strategies. Moreover, evidence for the indirect effects of PTSD symptom severity on negative affect and cortisol reactivity through both adaptive and maladaptive emotion regulation strategies was found. Implications of findings are discussed.

Section snippets

Participants

Participants were 133 patients (59 women) from an inpatient SUD treatment facility who reported exposure to a PTSD Criterion A traumatic event (APA, 2013) on the Clinician-Administered PTSD Scale (Blake et al., 1990). Participants ranged from 18 to 60 years of age (Mean = 34.59, SD = 10.28) and were ethnically diverse (52.6% White; 45.1% African American; 0.8% Latina/o, 0.8% Native American, 0.8% Asian American). Regarding educational attainment, 31.6% of participants reported receiving their

Preliminary data

The mean PTSD symptom severity score of participants on the Clinician-Administered PTSD Scale was 27.87 (SD = 35.15; range = 0–106), and 34.6% (n = 46) met criteria for a current diagnosis of PTSD. With regard to the specific traumatic events reported by participants that met Criterion A for PTSD, 20.3% reported the sudden, unexpected death of a loved one; 18.0% reported assault with a weapon; 15.0% reported physical assault; 15.0% reported sexual assault; 12.8% reported a transportation

Discussion

The present study sought to examine the relations of PTSD symptom severity to the use of specific emotion regulation strategies in the context of trauma-related emotional distress among trauma-exposed SUD patients, as well as the indirect relations of PTSD symptom severity to trauma cue reactivity through different emotion regulation strategies. Consistent with past findings that PTSD is associated with emotion regulation strategies characterized by emotional avoidance or control (Bardeen et

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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^☆: This study was supported in part by R21 DA030587 awarded to the second author (MTT) from the National Institute on Drug Abuse of the National Institutes of Health.

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PTSD Symptom Severity and Emotion Regulation Strategy Use During Trauma Cue Exposure Among Patients With Substance Use Disorders: Associations With Negative Affect, Craving, and Cortisol Reactivity☆

Highlights

Abstract

Section snippets

Participants

Preliminary data

Discussion

Conflict of Interest Statement

Clinical Psychology Review

Journal of Contextual Behavioral Science

Behavior Therapy

Drug and Alcohol Dependence

Journal of Affective Disorders

Behavior Therapy

Personality and Individual Differences

Journal of Psychiatric Research

Drug and Alcohol Dependence

Addictive Behaviors

Psychoneuroendocrinology

Psychoneuroendocrinology

Behavior Therapy

Behavior Therapy

Journal of Anxiety Disorders

Personality and Individual Differences

Addictive Behaviors

Journal of Psychiatric Research

Psychoneuroendocrinology

Addictive Behaviors

European Psychiatry

Biological Psychiatry

Journal of Anxiety Disorders

Behavior Therapy

Journal of Anxiety Disorders

Addictive Behaviors

Drug and Alcohol Dependence

Journal of Anxiety Disorders

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders

The moderating role of distress tolerance in the relationship between posttraumatic stress disorder symptom clusters and suicidal behavior among trauma exposed substance users in residential treatment

Archives of Suicide Research

Addiction motivation reformulated: an affective processing model of negative reinforcement

Psychological Review

On the nonconscious of emotion regulation

A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1

The Behavior Therapist

Substance abuse and posttraumatic stress disorder

Current Directions in Psychological Science

Posttraumatic stress disorder and substance abuse relapse among women: A pilot study

Psychology of Addictive Behaviors

Substance use disorder and posttraumatic stress disorder comorbidity: Addiction and psychiatric treatment rates

Psychology of Addictive Behaviors

Twenty-four-hour ambulatory assessment of heart rate and blood pressure in chronic PTSD and non-PTSD veterans

Journal of Traumatic Stress

Acceptability and suppression of negative emotion in anxiety and mood disorders

Emotion

Borderline personality features moderate emotional reactivity and emotion regulation in response to a laboratory stressor

Journal of Experimental Psychopathology

Emotion regulation and the anxiety disorders: An integrative review

Journal of Psychopathology and Behavioral Assessment