The Role of Emotion Regulation Difficulties in the Relation Between PTSD Symptoms and the Learned Association Between Trauma-Related and Cocaine Cues

ABSTRACT

Background: PTSD and cocaine dependence frequently co-occur. However, few studies have specifically examined the functional relation between trauma-related distress and cocaine use and none have examined the extent to which PTSD is associated with a learned association between trauma cues and cocaine or the underlying role of emotion regulation difficulties in this relation. Objectives: Thus, this study used a novel version of the Implicit Association Test (IAT) to examine the relation of PTSD symptoms to the strength of the trauma-cocaine cue association and the role of specific emotion regulation difficulties in this relation. Methods: A sample of 42 cocaine-dependent inpatients with a history of interpersonal traumatic exposure were recruited. Participants completed a series of questionnaires assessing PTSD symptom severity and emotion regulation difficulties. Participants then completed the IAT. Results: Results revealed a significant indirect relation of PTSD symptom severity to the strength of the trauma-cocaine cue association through the specific emotion regulation dimension of difficulties controlling impulsive behaviors when distressed. Conclusion/Importance: Results build upon extant research suggesting that factors related to emotional responding and regulation may underlie the relation between trauma-cue exposure and responses to cocaine cues among cocaine dependent patients with PTSD. The finding that PTSD symptom severity is associated with the strength of the trauma-cocaine cue association through one particular dimension of emotion regulation difficulties, difficulties controlling impulsive behaviors when distressed, highlight the potential utility of interventions focused on improving emotion regulation and impulse control abilities among trauma-exposed cocaine dependent patients.

KEYWORDS:

• Cocaine dependence
• emotion dysregulation
• implicit associations
• substance use disorders
• trauma

Glossary

• Emotion regulation: A multidimensional construct involving the awareness, understanding, and acceptance of emotions, ability to control impulsive behaviors and engage in goal-directed behaviors when experiencing negative emotions, flexible use of situationally appropriate strategies to modulate the intensity or duration of emotions rather than to eliminate emotions, and a willingness to experience negative emotions in pursuit of desired goals.

• Implicit Association Test: A computerized categorization task that requires respondents to sort stimulus items into target and attribute dimensions that share response options. Reaction time is used as a measure of the strength of the association between stimuli.

• Posttraumatic Stress Disorder: A trauma and stressor-related disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders that is characterized by the experience of re-experiencing symptoms, negative alterations in cognition and mood, avoidance, and hyperarousal symptoms following exposure to a traumatic event.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This work was supported by the National Institute on Drug Abuse [Grant number R01 DA019405].

Notes

1 To further ensure that our findings were not influenced by type of interpersonal traumatic event experienced, we tested three moderated mediation models with each type of interpersonal traumatic event (i.e., physical assault, sexual assault, and assault with a weapon) operating as a moderator of the demonstrated mediational model. Results revealed no evidence of moderated mediation.

Additional information

Notes on contributors

Matthew T. Tull

Matthew T. Tull, Ph.D., is an Associate Professor and Director of Anxiety Disorders Research in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center. Dr. Tull's research focuses on emotion dysregulation within the anxiety disorders, with a particular focus on PTSD. Currently, Dr. Tull is investigating specific behaviors associated with emotion dysregulation and avoidance (e.g., substance use, risky sexual behavior) and their association with negative clinical outcomes (e.g., residential substance abuse treatment drop-out, HIV infection) among substance dependent patients with PTSD. Dr. Tull utilizes a multi-method approach in his investigations, examining biological (e.g., cortisol), psychophysiological (e.g., heart rate variability), behavioral, and subjective indices of emotion dysregulation.

Kim L. Gratz

Kim L. Gratz, Ph.D., is a Professor in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center, where she serves as Director of the Division of Gender, Sexuality, and Health, and Director of Personality Disorders Research and the Dialectical Behavior Therapy (DBT) Clinic. Dr. Gratz's clinical and research interests focus on the role of emotion dysregulation in borderline personality disorder (BPD), self-injury, and other risky behaviors (including suicidal behaviors, substance misuse, and risky sexual behaviors). In particular, her research focuses on understanding the nature and consequences of emotion dysregulation in these conditions (through the use of novel behavioral/experimental paradigms), and applying this understanding to the development of more effective treatments. She is also interested in the intergenerational transmission of BPD-relevant personality traits and emotion regulation capacity from mothers to infants.

Michael J. McDermott

Dr. Michael J. McDermott's research interests broadly focus on the influence of psychological disorders on physical health conditions. His current research examines the roles of stress, anxiety, and trauma-related disorders on physical health, particularly migraine and other chronic pain conditions, and the mechanisms by which they contribute to medical problems and health risk behaviors (e.g., substance use). A primary goal of his program of research is exploring cognitive-emotional mechanisms (e.g., attentional processing, anxiety sensitivity, emotion dysregulation) that may underlie psychological factors and physical health. Through this research he hopes to inform targeted and unified psychological treatments for these medically relevant populations.

Michael J. Bordieri

Michael J. Bordieri, Ph.D., is an assistant professor of psychology at Murray State University. He earned a doctorate degree in clinical psychology from the University of Mississippi and was a psychology resident at the Mississippi Psychology Residency Training Program. His research interests broadly fall under the umbrella of translational work linking acceptance and mindfulness treatment components to basic behavioral processes. More specifically, he is interested in the development and refinement of Relational Frame Theory (RFT) based behavioral measures that target processes posited by the psychological flexibility model.

Stacey B. Daughters

Dr. Stacey B. Daughters is an Associate Professor in the Clinical Psychology program in the Department of Psychology and Neuroscience at the University of North Carolina, Chapel Hill. Her research expertise includes the neurobiological and behavioral mechanisms contributing to addiction, with a focus on stress and mood disorders, and the translation of this knowledge into effective treatments.

Carl W. Lejuez

Carl W. Lejuez, Ph.D., is the Dean of the College of Liberal Arts and Sciences at the University of Kansas. His previous position was at the University of Maryland as a Professor of Psychology and the Founding Director of the Center for Addictions, Personality, and Emotion Research. Dr. Lejuez's research is translational in nature. He uses laboratory methods to understand mechanisms of addiction and seeks to apply this information in the development of novel assessment and treatment strategies. His research spans the clinical domains of addictions, personality pathology, and mood disorders, and he is most interested in the common processes across these conditions. His research has been funded continuously by NIH (including NIDA, NIAAA, NCI, and NIA) since 2002.