Emotion Dysregulation in Comorbid Posttraumatic Stress Disorder and Substance Use Disorders: A Narrative Review

Co-occurrence of substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) is extremely common and is associated with elevated dropout and relapse rates. Given that PTSD/SUD co-occurrence rates among veterans have been found to be as high as 55?75%, it is important to identify mechanisms that may affect the interplay of both disorders. Emotion dysregulation (ED) presents a candidate mechanism that may underlie poor treatment response in co-occurring PTSD/SUD. This article proposes a transdiagnostic emotion regulation framework that considers ED conceptualized as a combination of low ability to tolerate emotional distress (low distress tolerance) and difficulties in the goal-directed use of emotion regulation strategies as a key risk factor in co-occurring PTSD/SUD. The authors review empirical findings from self-report and laboratory-based studies of ED in PTSD. They describe psychological explanations of the emotion-substance relationship and review studies documenting ED in SUDs and in co-occurring PTSD/SUD. The literature on ED in PTSD/SUD suggests that (a) patients with PTSD may resort to substances to cope with trauma-related symptoms due to ED, and (b) ED may maintain SUD symptoms and interfere with psychological treatment. Longitudinal studies on bidirectional relationships between ED and substance use in PTSD are needed, particularly research examining the course of ED in PTSD patients who use substances versus those who do not.     

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.     

Mental Health Services Use Intentions Among Canadian Military Recruits

Identifying the factors associated with mental health services use (MHSU) is an important step in developing strategies to improve services access and delivery. The aims of the present study were to (a) identify personality and individual difference characteristics associated with MHSU intentions within the framework of the Theory of Planned Behavior (TPB) and (b) explore complex relationships that might exist between these characteristics and determinants of MHSU intentions identified in TPB, including attitudes, subjective norms, and perceived behavioral control. Data for 244 Canadian Armed Forces recruits who completed a MHSU questionnaire following mental health training were linked to personality data collected earlier. Multivariate analyses showed that the relationship between agreeableness and MHSU intentions was mediated by instrumental attitudes and subjective norms. The relationship between hardiness and MHSU intentions was mediated by subjective norms and self-efficacy. Findings suggest it may be worthwhile to consider mental health education initiatives to improve MHSU.     

Examining a negative halo effect to anabolic steroids users through perceived achievement goals,sportspersonship orientations,and aggressive tendencies

We investigated the social image of anabolic steroids (AS) users grounding our analysis on the achievement goal theory of Nicholls. Our main goal was to explore how an athlete’s acceptance of AS use would impact on the way that athlete will be perceived by others. Non‐AS‐using participants reacted to one of two scenarios portraying a male athlete either accepting or refusing to engage in drug use behavior. The results suggested that the acceptance of anabolic steroids yielded an unfavorable social image – perceivers inferred a predominant ego orientation to characterize the AS‐user’s motivation as well as weaker sportspersonship and a stronger proclivity for reactive aggression than instrumental aggression. Moreover, the analyses did not yield significant gender or interaction effects. Finally, those findings are commented in view of methodological shortcomings and of the perspectives that they may offer for future research concerning the motivational aspects of the social perceptions of drug use in sport.     

Internet‐based CBT intervention for gamblers in Finland: Experiences from the field

From September 2007 to May 2011 a total of 471 participants (325 males and 146 females) signed up for an 8‐week Internet‐based cognitive behavioral therapy offered for gamblers in Finland. Sixty‐four percent of the participants were pathological gamblers (PGs) (NODS 5> points), 14% were problem gamblers (NODS 3–4 points) and 10% were at risk of gambling problems (NODS 1–2 points). Two hundred and twenty four participants completed the treatment and after the treatment period significant changes were found in the following variables: gambling related problems (NODS), gambling urge, impaired control of gambling, alcohol consumption (AUDIT‐C), social consequences, gambling‐related cognitive erroneous thoughts and depression (MARD‐S). In this sample co‐morbid alcohol consumption was stronger among males. The main finding of this study was that the onset age of gambling was associated with a greater amount of gambling‐related cognitive erroneous thoughts.     

Ventral encoding of functional affordances: A neural pathway for identifying errors in action

Functional tool usage is a critical aspect of our daily lives. Not only must we know which tools to use for a specific action goal, we must also know how to manipulate those tools in meaningful way to achieve the goal of the action. The purpose of this study was to identify the regions of the brain critical to supporting the process of understanding errors in tool manipulation. Using fMRI, neural activations were recorded while subjects were presented with images demonstrating typical action scenes (screwdriver used on a screw), but with the tool being manipulated either correctly (screwdriver held by handle) or incorrectly (screwdriver held by bit rather than handle). Activations in fMRI for identifying correct over incorrect tool manipulation were seen along the canonical parietofrontal action network, while activations for identifying incorrect over correct tool manipulation were primarily seen at superior temporal areas and insula. We expand our hypotheses about ventral brain networks identifying contextual error to further suggest mechanisms for understanding functional tool actions, which collectively we regard as functional affordances. This proposes a fundamental role for ventral brain areas in functional action understanding.     

Negotiating safer sex: A detailed analysis of attitude functions,anticipated emotions,relationship status and gender

Objective : Because interpersonal discussion about condom use can encourage subsequent condom use, this project aims to examine the psychological antecedents of intentions to discuss or request the use of condoms with a sexual partner.

Method : The data were collected from 849 heterosexual college students in the USA through an online survey. The survey contained several measures related to attitude functions (i.e. motivations), efficacy, norms and intentions to discuss condom use with a sexual partner.

Results : Participants’ attitude functions weakly predicted intentions to discuss condom use. Communication efficacy was a more important predictor of intentions for females (vs. males) and for those in other relationships or not in a relationship (vs. long-term monogamous relationships). Anticipated negative emotions were a stronger predictor of intentions for those in long-term monogamous relationships (vs. other relationships or not in a relationship).

Implications : Future research needs to consider more detailed attitude functions and anticipated emotions. Furthermore, background variables (e.g. gender and relationship status) can be moderators in addition to being distal predictors.     

Perceived behavioural control,subjective norms,attitudes and intention to use condom: A longitudinal cross-lagged design

Based on the Theory of Planned Behaviour (TPB), the purpose of this investigation was to examine the directionality of the association among condom use, intention, attitudes, subjective norms and perceived behavioural control. The present study investigated the nature of these relationships using a longitudinal cross-lagged design applied to data from a cohort of 958 randomly selected Italian adults. Using structural equation modelling, two cross-lagged panel analyses revealed reciprocal relationships between intention and attitudes and between intention and condom use. Contrary to expectations, baseline subjective norms and perceived behavioural control did not predict subsequent intention to use condom when controlled for the autoregressive effect of intention at T1 on the same variable at T2. Also, perceived behavioural control at T1 did not influence condom use at T2 after controlling for the effect of baseline intention. The possibility of reciprocity was also tested for all relations and significant results were found. The moderation effect of perceived behavioural control on the relationship between intention and condom use was not significant. The differences in age, gender and partnership status were taken into account in the analyses.     

A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program

Abstract

Screening for head and neck cancer is underutilized. Given that lack of knowledge of the risk factors may partially account for screening underutilization. we surveyed subjective risk and knowledge of risk factors for head and neck cancer among 124 individuals who attended a free. hospital-based head and neck cancer screening. Few participants were current smokers. Most attendees perceived their risk as similar to others of their age and sex. Personal health habits comprised almost all of the risk-decreasing factors, yet less than half of the risk-increasing factors. generated. Personal habits were less frequently endorsed than factors such as pollution and heredity. Those who mentioned a risk behavior, or a family cancer history, reported higher subjective risk. Those who mentioned a personal health habit reported lower subjective risk. Results highlight needed efforts to increase screening among high-risk individuals through targeted education messages.