Longitudinal Associations between Sleep, Intrusive Thoughts, and Alcohol Problems Among Veterans

Abstract

Background: Research suggests bidirectional associations between symptoms of posttraumatic stress disorder (PTSD) and sleep disturbance, both of which have been associated with alcohol problems. However, few studies have examined the interplay of these conditions in predicting alcohol problems over time. This study tested 2 competing models: (i) sleep disturbance as a mediator of the association between intrusive thoughts about trauma and alcohol problems and (ii) intrusion symptoms as the mediator of the sleep/alcohol problem association.Methods: Veterans (N = 325, 93% male, 81% White) completed assessments at baseline, 6 months, and 12 months as part of a larger observational study. Zero-inflated-negative binomial models were used to examine indirect effects of baseline predictors on (i) yes/no likelihood and (ii) number of 12month alcohol problems through 6-month mediators. Models controlled for past-year cannabis use and drinks consumed per week at baseline.Results: The only significant predictor of alcohol problem likelihood was baseline drinking quantity. Baseline PTSD intrusions had a direct effect on number of alcohol problems at 12 months, with no indirect (mediated) effect through 6-month sleep disturbance. In the competing model, baseline sleep disturbance had a marginally significant direct effect on 12-month alcohol problems, with a significant indirect effect through 6-month PTSD intrusions.Conclusions: PTSD intrusions are associated with more alcohol problems and help explain the long-term association between sleep and alcohol problems among veterans. Because sleep disturbances are associated with more intrusive thoughts about trauma, we recommend that treatments targeting sleep in the context of PTSD and alcohol use include a cognitive component.

Associations between individual cognitive factors, mode of exposure and depression symptoms in practitioners working with aversive crime material

“…In addition, we found thought suppression as a potential risk factor of depression. This finding is consistent with the Ironic Process Theory (Beevers et al, 1999 ) and previous literature where depressed individuals suppressing their thoughts tend to have worsening depression symptoms (Miller et al, 2019 ; Wenzlaff et al, 2001 ). Again, this requires confirmation via an experimental/longitudinal design.…”

“…Duran and Woodhams ( 2022 ) found that analytical practitioners cope with the nature of their work by actively suppressing unwanted intrusive thoughts related to traumatic material when they come to mind. However, in the literature (Ehlers & Clark, 2000 ), this is considered maladaptive because the suppression of recollections of the traumatic event can increase the likelihood of them coming back to mind (Miller et al, 2019 ). Thought suppression could be a protective factor when stress levels are low, but it could be a risk factor when life stress increases.…”

Traumatic Childhood Experiences and Posttraumatic Stress Disorder Among Veterans in Substance Use Disorder Treatment

“…Intrusive thoughts and hyperarousal, however, remained significantly associated with childhood emotional and physical abuse in the military trauma group. Among veterans, PTSD's intrusive thoughts are associated with more alcohol problems (Miller et al, 2019) and hypervigilance is associated independently with both PTSD and military deployment (Kimble et al, 2013). In contrast with the military trauma group, the civilian trauma group showed no significant symptom cluster associations with childhood physical abuse, instead expressing the range of symptoms in association with childhood emotional and sexual abuse.…”

Impact of Traumatic Material on Professionals in Analytical and Secondary Investigative Roles Working in Criminal Justice Settings: a Qualitative Approach

“…Some participants volunteered coping strategies that could be maladaptive. For example, some used thought suppression to cope and models of PTSD (e.g., Ehlers and Clarke 2000) caution that such methods could exacerbate PTSD-like symptoms such as intrusive thoughts (Birrer et al 2007;Miller et al 2019). Similarly, emotional detachment and processing material at a shallow level could aggravate PTSD-like symptoms as they prevent sufficient processing of the traumatic material to avoid or escape the fear (Shay and Munroe 1999).…”