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

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.

The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges.

“…Thus, although self-report is not sufficient for a comprehensive assessment of affective processes and internalizing symptoms, it does provide necessary and critical information. Whenever possible, self-report measures should be used in conjunction with other levels of analysis (e.g., genes, psychophysiology, neurological circuits, cognitive measures, behavioral outcomes) to combine complementary sources of information and yield a more complete picture of affective experience (see, for example, Stange et al, 2017; Tull et al, 2018). It is also important to use psychometrically-sound self-report measures that were thoughtfully selected for the specific research question at hand.…”

<p>The interactive effects of stress and coping style on cognitive function in patients with schizophrenia</p>

“…Some studies on stress and cognitive impairment may help explain this phenomenon. Stress may lead to maladaptive responses that could elevate cortisol levels,31,32 which were significantly related to impaired memory function in schizophrenia 33. The maladaptive emotion regulation significantly predicted an increased affective and reduced cortisol response 34.…”

Development of a novel, integrated cognitive-behavioral therapy for co-occurring posttraumatic stress and substance use disorders: A pilot randomized clinical trial

“…To assess cue reactivity, a well-established script-driven paradigm to measure trauma and substance cue reactivity [e.g., 72] was utilized. The script-driven cue reactivity paradigm was selected for this study to create individualized, emotionally salient trauma and substance cues and account for the diverse experiences of participants.…”