Dimensions of Emotion Regulation in PTSD-Related Drinking Risk: A Proof of Concept Study

ABSTRACT The more than 10 million adults in the U.S. with posttraumatic stress disorder (PTSD) are at substantially increased risk for a range of harmful drinking outcomes. Difficulty regulating PTSD-related affect (emotion regulation; ER) is a core feature of this drinking risk and is a key intervention target. Effective treatments for PTSD-related drinking that target ER exist. However, instrumental and structural barriers to these traditional in- person interventions impede access. Mobile interventions could be developed to train adaptive ER in response to PTSD symptoms as they occur in the contexts of daily life, offering an accessible treatment option. Yet the development of such interventions will be profoundly limited—and could even be detrimental—without a fundamental understanding of how ER influences PTSD-related drinking in real-time in daily life. This knowledge is not currently available. ER efforts in daily life can be intentional or automatic. These two ER dimensions are distinct, with unique implications for intervention. Intentional ER includes efforts to regulate affective responding that a person is aware of and can report on. In contrast, automatic ER occurs without conscious awareness, and thus is not well captured by self-report. The majority of studies of ER in PTSD-drinking rely on self-report and thus pertain only to intentional processes. We are aware of no studies that have examined automatic ER processes or their role in PTSD-related drinking risk in daily life contexts. This poses an obvious obstacle to intervention development. Studies delineating these unique risk processes as they occur in daily life are needed. To address these gaps in the knowledge base, we will combine methods to examine intentional (via EMA self-report) and automatic (via ambulatory high frequency heart rate variability; HF-HRV) dimensions of ER in PTSD-related drinking risk processes in real-time. Individuals with PTSD (N=110) will complete a baseline assessment, and a 14-day ecological momentary assessment (EMA) protocol with multiple daily reports to examine how dynamic shifts in PTSD symptoms and ER lead acutely to drinking risk in the course of daily life. Our primary aim (Aim 1) examines how changes in PTSD symptoms are linked to cognitive (urge to drink) and behavioral (alcohol seeking, drinking) drinking risk. In Aim 2 we will expand our model to examine how each unique ER dimension (intentional, automatic) is influenced acutely by PTSD symptom changes, and how these ER dimensions pre-sage drinking at the event-level. Finally, in Aim 2 we will test the two dimensions of ER as distinct mechanisms of PTSD-related drinking risk that could be targeted in intervention. In exploratory Aim 3, we will test PTSD symptom cluster specificity in intentional and automatic ER risk processes. Results from this developmental work will support a larger examination of event-level ER in PTSD-related drinking and may inform interventions that employ current technologies to reduce drinking risk as it occurs in daily life.