What Is the Role of Affective Cognition in Trauma and Posttraumatic-Stress-Disorder-Related Drinking? A Systematic Review

Trauma and posttraumatic stress disorder (TR/PTSD) are implicated in deleterious alcohol outcomes, yet the processes that undergird these associations remain elusive. Affective (i.e., emotionally laden) cognitions may play key roles in TR/PTSD-related drinking that could inform prevention and intervention. In the present review, we synthesized extant literature (k = 58) on affective cognitions and their role in negative- and positive-reinforcement TR/PTSD-related drinking, including alcohol-specific (e.g., drinking motives, alcohol expectancies) and non-alcohol-specific (e.g., emotion-regulation cognitions, perception and attentional biases) cognitions. Findings generally supported the importance of alcohol-specific cognitions in negative-reinforcement drinking more so than positive-reinforcement drinking. Non-alcohol-specific affective cognitions were considerably less researched. Several gaps in the knowledge base emerged; studies were overwhelmingly cross-sectional, conducted mainly within homogeneous college samples, and often did not disaggregate effects of trauma exposure from those of PTSD. Future research is needed to address these gaps to optimally inform clinical efforts to reduce TR/PTSD-related drinking risk.