Examining changes in negative mood regulation expectancies, posttraumatic stress disorder, depression, and substance use following integrated cognitive-behavioral therapy

ABSTRACT

Background: The comorbidity of depression, posttraumatic stress disorder (PTSD), and substance use disorder (SUD) is common among veterans. Some research indicates that poor expectancies for negative mood regulation (NMR) may be associated with depression, trauma symptoms, and substance abuse. However, little is known about whether NMR expectancies can be changed through psychotherapy and if so, whether changes in NMR expectancies are related to changes in depression, PTSD, and SUD. Methods: Therefore, this study examined (1) whether NMR expectancies correlate with depression, PTSD, and SUD symptoms; (2) whether NMR expectancies improve after group integrated cognitive-behavioral therapy (ICBT); and (3) whether these changes were associated with improvements in depression, PTSD, and SUD symptoms in a sample of 123 veterans (89% male, 64% non-Hispanic Caucasian) recruited from a Department of Veteran Affairs (VA) Healthcare System. Results: Findings indicated that (1) NMR expectancies were significantly associated with depression and PTSD symptoms but not substance use at baseline; (2) NMR expectancies significantly improved following group ICBT treatment; (3) following treatment, improvements in NMR expectancies were associated with decreases in depression and PTSD symptoms but were unrelated to changes in substance use outcomes; and (4) baseline NMR expectancies did not predict treatment outcomes. Similarly, pre-post NMR expectancies change scores were significantly associated with changes in depression and PTSD symptoms, but not percentage days using or percentage days heavy drinking. Conclusions: In conclusion, this study suggests that group ICBT is associated with improvements in NMR expectancies among veterans with depression, PTSD, and SUD, which are associated with improvements in depression and PTSD symptoms.

KEYWORDS:

• Depression
• drinking
• Mood regulation
• NMR
• PTSD
• substance use
• trauma
• veterans

Funding

This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research & Development Merit Review Award to Susan R. Tate. Further, this material is based upon work supported by the Office of Academic Affiliations, Department of Veterans Affairs. These entities had no role in the study design, data collection, writing, or submission of this paper for publication.

The current study uses data from a larger clinical trial (NCT00958217, VA Merit 5101CX000290). The authors declare that they have no actual or potential conflicts of interest.

Author contributions

Emma Siegel conceived of the questions addressed in this article and was the primary author. Dr. Moira Haller conducted study analysis and contributed to the development of the manuscript. Ruifeng Cui contributed to the literature review and drafting of the manuscript. Dr. Ryan S. Trim contributed to the writing of the manuscript. Dr. Susan R. Tate was the principal investigator of the study from which these data were drawn and contributed to the writing of the manuscript. Dr. Sonya B. Norman contributed to the design of the study and to the development and writing of the manuscript.