PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among College Students With a Trauma History

Abstract

Objective Posttraumatic stress disorder (PTSD), alcohol use, and alcohol-related consequences have been linked to emotion dysregulation. Sex differences exist in both emotion regulation dimensions and alcohol use patterns. This investigation examined facets of emotion dysregulation as potential mediators of the relationship between PTSD symptoms and alcohol-related consequences and whether differences may exist across sexes. Methods Participants included 240 college students with a trauma history who reported using alcohol within the past three months and completed measures of PTSD symptoms, emotion dysregulation, alcohol consumption, alcohol-related consequences, and negative affect. The six facets of emotion dysregulation were examined as mediators of the relationship between PTSD symptoms and alcohol-related consequences in the full sample and by sex. Results There were differences in sexes on several variables, with women reporting higher PTSD scores and Lack of Emotional Awareness. Men reported significantly higher drinks per week in a typical week and a heavy week. There were significant associations between the variables for the full sample, with PTSD showing associations with five facets of emotion dysregulation subscales: Impulse Control Difficulties when Upset, Difficulties Engaging in Goal-Directed Behavior, Nonacceptance of Emotional Responses, Lack of Emotional Clarity, and Limited Access to Emotion Regulation Strategies. Alcohol-related consequences were associated with four aspects of emotion dysregulation: Impulse Control Difficulties when Upset, Difficulties Engaging in Goal-Direct Behavior, Nonacceptance of Emotional Reponses, and Limited Access to Emotion Regulation Strategies. Two aspects of emotion regulation, Impulse Control Difficulties and Difficulties Engaging in Goal Directed Behavior, mediated the relationship between PTSD symptoms and alcohol-related consequences in the full sample, even after adjusting for the effects of negative affect. When examined separately by gender, Impulse Control Difficulties remained a mediator for men and Difficulties Engaging in Goal Directed Behavior for women. Conclusions These analyses shed light on processes that may underlie “self-medication” of PTSD symptoms. Gender-specific interventions targeting emotion dysregulation may be effective in reducing alcohol-related consequences in individuals with PTSD. Women may possibly benefit from interventions that focus on difficulties engaging in goal-directed behavior, while men may benefit from interventions that target impulse control difficulties when upset.

Mechanistic role of emotion regulation in the PTSD and alcohol association.

“…According to authors of one study, this may have been due to restricted range of alcohol behaviors (Klemanski et al, 2012). The other study found evidence of mediation for the impulse control and emotional clarity facets only when examining solely men (Tripp & McDevitt-Murphy, 2015). Thus, more research examining multi-dimensional aspects of emotion regulation as a mediator of PTSD-alcohol associations is needed, as findings have been mixed and have been unable to parse out the effects of trauma and PTSD in considering these mediated pathways.…”

“…Although the mediating role of some specific aspects of emotion regulation have been tested (e.g., non-judgmental acceptance, see Vujanovic, Bonn-Miller, & Marlatt, 2011), in general, studies examining the full, multi-dimensional emotion regulation construct have been sparse and findings have been somewhat mixed. In one of only a handful of such studies, authors found that some facets of emotion regulation (i.e., difficulty with impulse control and goal-directed behavior when upset) mediated the association between PTSD symptoms and alcohol-related consequences in a sample of college students, but assessment of trauma and PTSD were self-report and analyses did not allow for comparisons between trauma exposure only and PTSD (Tripp et al, 2015). Findings from two other studies using military samples did not find emotion regulation to mediate the PTSD-alcohol association (Klemanski, Mennin, Borelli, Morrissey, & Aikins, 2012; Tripp & McDevitt-Murphy, 2015).…”

Transdiagnostic neural correlates of volitional emotion regulation in anxiety and depression

“…One such example of symptom overlap across those with anxiety and depressive disorders is emotion dysregulation, as evinced by reports of negative biases (Beck & Clark, 1997;Gotlib, Krasnoperova, Yue, & Joormann, 2004) and difficulty in managing negative emotions in ways that are adaptive (Aldao, Nolen-Hoeksema, & Schweizer, 2010;Amstadter, 2008;Fernandez, Jazaieri, & Gross, 2016;Hostinar, Nusslock, & Miller, 2017;Shapero, Abramson, & Alloy, 2016;Tripp, McDevitt-Murphy, Avery, & Bracken, 2015;Tull, Bardeen, DiLillo, Messman-Moore, & Gratz, 2015). A well-studied form of emotion regulation is cognitive reappraisal, an antecedent emotion regulation strategy that occurs prior to or when an emotional experience is unfolding and involves the cognitive transformation (e.g., reinterpretation) of an emotional experience in order to change its emotional meaning (Gross, 1998).…”

A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions

“…Moreover, earlier substance use may increase likelihood of later substance dependence (Chen et al, 2009), with these difficulties also playing a role in the emergence of offending behaviour into adulthood (Wiesner et al, 2005). Researchers and clinicians remain divided regarding whether or not substance use is an independent cause of mental health problems and vice versa (Burns, 2013;Mathews et al, 2013;McLaren et al, 2010;Seddon, 2010;Tripp et al, 2015;Wahlstrom et al, 2015) and the extent to which substance use leads to crime also remains in contention (Seddon, 2010).…”

“…Moreover, such correlation studies tend to be specific to population, circumstance and measures thus rarely lead to robust interventions (Tripp et al, 2015;Wahlstrom et al, 2015).…”