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Background Clinical research indicates that successful posttraumatic stress disorder (PTSD) treatment does not lead to improvements in alcohol use outcomes in comorbid PTSD and alcohol use disorder (AUD). Emerging theory suggests that treating PTSD may not disrupt an association between negative affect and alcohol craving, which underlies negative reinforcement drinking. The goal of the current study was to determine the respective influences of PTSD symptoms, coping motives, and negative affect on trauma and alcohol cue reactivity to inform theoretical models of co-occurring PTSD and AUD. Methods The sample consisted of 189 young adults (50.3% women; 49.2% current PTSD; 84.0% current AUD) who endorsed interpersonal trauma (e.g., sexual/physical assault) and current weekly alcohol use. Participants completed a trauma and alcohol cue reactivity assessment, in which subjective (e.g., craving, affect) and physiological (i.e., salivation) measures were recorded in response to 4 narrative (i.e., personalized trauma or standard neutral) and in vivo beverage (i.e., personalized alcohol or water) cue combinations. Results Forward-fitted linear mixed-effects (LME) models confirmed that trauma cue-elicited craving was elevated among those high but not low in PTSD symptoms, consistent with prior research and theory. Trauma cue-elicited craving was fully explained by increases in negative affect, with no evidence of a direct effect of trauma cue on craving. PTSD symptoms moderated an association between trauma cue and negative affect (but not negative affect and craving), and coping motives for alcohol moderated an association between negative affect and craving (but not trauma cue and negative affect). Conclusions This study provides novel laboratory evidence for the respective contributions of negative affect, PTSD symptoms, and coping motives on alcohol craving in trauma-exposed drinkers. It offers a methodological framework in which to evaluate novel strategies that aim to disrupt negative reinforcement drinking in individuals with co-occurring PTSD and AUD.

STUDY OBJECTIVES: Trauma-related nightmares are highly prevalent among veterans and are associated with higher-severity insomnia and posttraumatic stress disorder. Cognitive behavioral therapy for insomnia (typically 6–8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and nontrauma-related bad dreams using an active control group treated using progressive muscle relaxation therapy. In addition, we tested whether baseline trauma-related nightmare frequency and baseline nontrauma-related bad dream frequency moderated changes in insomnia severity. METHODS: Participants were 91 military veterans with insomnia disorder randomized to BBTI or progressive muscle relaxation therapy. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and nontrauma-related bad dream frequency on the Pittsburgh Sleep Quality Index–PTSD Addendum. RESULTS: We found that BBTI significantly reduced trauma-related nightmares from baseline to posttreatment, whereas progressive muscle relaxation therapy did not. However, reductions in trauma-related nightmares were not maintained at the 6-month follow up. Neither BBTI nor progressive muscle relaxation therapy reduced nontrauma-related bad dreams from baseline to posttreatment. We also found that neither baseline trauma-related nightmare frequency nor baseline nontrauma-related bad dream frequency moderated changes in insomnia symptom severity. CONCLUSIONS: Findings from the current study suggest that BBTI may help reduce trauma-related nightmares. Further research is needed to better understand the potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); URL: https://clinicaltrials.gov/ct2/show/NCT02571452; Identifier: NCT02571452. CITATION: Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med. 2022:18(7):1831–1839.

College students demonstrate high rates of depression and anxiety, particularly among students with self-reported history of trauma exposure. Neuroticism, a personality trait characterized by emotional instability and negative affect, is consistently associated with internalizing symptoms; however, our understanding of malleable risk characteristics that help to clarify these associations between neuroticism and internalizing symptoms is limited. The current study investigated whether anxiety sensitivity (AS) and/or distress tolerance (DT) would predict changes in internalizing symptoms (depression and anxiety), beyond the effects of neuroticism, in a high-risk sample of college students. Participants were 316 college students (75.9% women) with self-reported history of interpersonal trauma exposure who participated in a university-wide longitudinal study of emotional health. Participants completed assessments of personality, AS, DT, depression, and anxiety over three time points spanning an average of 26 months. Results of structural equation modeling demonstrated that higher AS predicted increases in depression and anxiety, and lower DT predicted increases in depression and anxiety (controlling for neuroticism). Neuroticism did not predict changes in depression or anxiety. These findings contribute to our understanding of the role of AS and DT in the development of depression and anxiety in trauma-exposed college students.

OBJECTIVES Findings are inconsistent regarding the relationship between worry and anxious arousal (AA). Effortful control (EC) capacity may explain these inconsistent findings, such that only high worriers with higher EC are able to suppress autonomic arousal through worrying. The current study investigated these main and interactive effects of worry and EC on AA as well as depression. METHODS Participants (N = 1210, 779 females) were recruited from Amazon's Mechanical Turk website and completed self-report measures assessing worry, EC, AA, depression, and negative affect intensity. RESULTS Regression models revealed that EC moderated the relationship between worry and AA, with individuals lower in EC demonstrating a stronger positive relationship between worry and AA. EC also moderated the relationship between worry and depression, with individuals lower in EC demonstrating a stronger positive relationship between worry and depression. Results remained the same when controlling for age, gender, and negative affect intensity. CONCLUSIONS Results support the idea that low EC may help to explain a range of comorbid psychiatric symptoms. PRACTITIONER POINTS Individuals low in effortful control demonstrate a stronger association between worry and anxious arousal, as well as between worry and depression Those low in effortful control may be especially vulnerable to comorbid worry and depression High worriers who are high in effortful control may be motivated to continue worrying due to their ability to reduce anxious arousal during worry.

Higher anxiety and depression in females becomes more pronounced in the transition from childhood to adolescence. Although previous research indicates that parental anxiety may predict anxiety and depression more strongly in girls than boys, there is a lack of longitudinal research investigating these relationships. The current study utilized longitudinal data (N = 940) to investigate our hypotheses that 1) mothers’ and fathers’ anxiety (at child age 7) would be more strongly associated with symptoms of adolescent anxiety and depression in girls than in boys, and 2) that greater increases in both mothers’ and fathers’ anxiety (from child age 7 to child age 15) would be more strongly associated with symptoms of adolescent anxiety and depression in girls than in boys. Structural equation modeling results indicated that higher mothers’ anxiety at child age 7, as well as higher increases in fathers’ anxiety (from child age 7 to child age 15), were associated with girls’ anxiety and depression at age 15, but not boys’ anxiety and depression at age 15. There were no child gender differences found in the associations between 1) fathers’ anxiety at child age 7 and child anxiety and depression at child age 15, or 2) change in mothers’ anxiety (from child age 7 to child age 15) and child anxiety and depression at child age 15. These results highlight important gender differences that may influence the development of anxiety and depression in adolescence.

Exposure to trauma (particularly interpersonal trauma), post-traumatic stress disorder (PTSD) symptoms, and low distress tolerance (DT; the ability to tolerate negative internal states), are all related to risk for alcohol use disorders (AUD). The aim of this study was to examine the main and interactive effects of PTSD symptom severity and DT in relation to current (past 30-day) alcohol consumption and binge drinking among emerging adult men and women with a history of sexual/physical assault. Participants were 572 undergraduate students (66% women) with a history of physical/sexual assault endorsing past month alcohol use. Participants completed the Distress Tolerance Scale (DTS), the PTSD Checklist for DSM-V (PCL-5), and an abbreviated Timeline Followback Questionnaire (TLFB), which assessed past 30-day total alcohol consumption (i.e., total number of drinks) and binge drinking frequency (i.e., 5+ drinks [4+ for women]). Negative binomial regression analyses revealed that male sex, higher trauma load (i.e., total number of trauma categories endorsed), and higher PTSD symptom severity were associated with both higher number of total drinks and higher frequency of binge drinking episodes. However, DT was not associated with either alcohol outcome when PTSD symptom severity was entered in the models. The interaction of PTSD symptom severity and DT was not significantly associated with total alcohol consumption or binge drinking. These results highlight the importance of investigating the unique contributions of PTSD symptoms and DT (as well as other transdiagnostic cognitive-affective constructs) in the onset and maintenance of AUD.

Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent and co-morbid among veterans. Moral injury (MI), which results from traumatic experiences that conflict with deeply held moral beliefs, is also associated with pain. However, relationships between different types of exposures to potentially morally injurious events (PMIEs) and pain have not yet been investigated. In the current study, we investigated these relationships between exposure to PMIEs (betrayal, witnessing, and perpetration) and different types of pain (joint pain, muscle pain, and overall pain intensity), while controlling for other relevant variables (including PTSD symptoms, combat exposure, adverse childhood experiences, age, gender, and race/ethnicity). We also examined gender differences in these associations. Participants were 11,871 veterans drawn from a nationwide, population-based survey who self-reported exposure to PMIEs, PTSD symptoms, frequency of adverse childhood experiences, combat exposure, sociodemographic information, past six-month joint pain, past six-month muscle pain, and past week overall pain intensity. Population weighted regression models demonstrated that PMIEs were not significantly associated with joint or muscle pain, but that betrayal was associated with past week overall pain intensity, even when controlling for all other variables. Models investigating men and women separately found that for women, betrayal was associated with joint pain and pain intensity, but for men, betrayal was not associated with any pain outcome. These findings suggest that it may be especially important to assess betrayal when treating patients with a history of trauma and chronic pain.

The comorbid diagnosis of generalized anxiety disorder (GAD) and depression is highly prevalent. Examining relationships between emotion regulation factors and depression in individuals high in trait worry (the cardinal symptom of GAD) may contribute to our understanding of this comorbidity. In the current study, we aimed to determine whether two emotion regulation factors—reappraisal (i.e., reinterpreting experiences) and suppression (i.e., not expressing emotion)—were associated with depression differentially in high versus low worriers. Participants were 206 high and low worriers (112 high worriers; 94 low worriers) recruited from Amazon’s Mechanical Turk website. Participants completed measures assessing reappraisal, suppression, and depression. Regression models revealed that among high worriers, low reappraisal was associated with higher depression, but that among low worriers, reappraisal was not associated with depression. In contrast, suppression was not differentially associated with depression in high and low worriers; higher suppression was associated with higher depression in both high and low worriers. These results are consistent with the idea that reappraisal may represent an especially helpful emotion regulation strategy for high worriers, potentially buffering against the negative effects of worry on depression.

The intolerance of uncertainty model of worry posits that individuals worry as a means to cope with the discomfort they feel when outcomes are uncertain, but few experimental studies have investigated the causal relationships between intolerance of uncertainty, situational uncertainty, and state worry. Furthermore, existing studies have failed to control for the likelihood of future negative events occurring, introducing an important rival hypothesis to explain past findings. In the present study, we examined how individuals with high and low trait intolerance of uncertainty differ in their behavioral, cognitive, and emotional reactions to situational uncertainty about an upcoming negative event (watching emotionally upsetting film clips), holding constant the likelihood of that negative event taking place. We found that although individuals high in trait prospective intolerance of uncertainty reported a higher degree of belief that being provided with detailed information about the upcoming stressor would make them feel more at ease, they did not experience an actual decrease in distress or state worry upon being provided with more information, during anticipation of the film clips, or during the film clips themselves. Our results suggest that heightened distress regarding negative events may be more central than intolerance of uncertainty to the maintenance of worry.

Posttraumatic stress disorder (PTSD) symptoms are associated with significant emotion dysregulation, which in turn marks risk for greater symptom-related difficulties and psychiatric comorbidity. Individuals with PTSD symptoms who are high in anxiety sensitivity (AS; fear of anxiety and related sensations) may have particular difficulty managing negative affect, as they tend to perceive their trauma-related symptoms to be more threatening. The present study investigated the main and interactive effects of PTSD symptoms (PTSD Checklist for DSM-5) and AS (Anxiety Sensitivity Index-3) on emotion dysregulation (Difficulties in Emotion Regulation Scale-16) in a sample of 836 trauma-exposed firefighters (94.6% men; Mage = 38.5 years, SD = 8.5). Results of hierarchical linear regression models indicated that the main effects of PTSD symptom severity (β = .353, p

Alcohol use problems are associated with suicidal desire and may provide an avenue to suicidal ideation and behavior. However, the influence of posttraumatic stress disorder (PTSD) on the nature of the relationship between alcohol use problems and suicide risk is not well understood. In particular, the potential for PTSD to moderate the association between alcohol use problems and suicide risk remains unexplored. The present study investigated the main and interactive effects of alcohol use problems (Alcohol Use Disorders Identification Test) and PTSD symptoms (PTSD Checklist for DSM-5) on suicide risk (Suicide Behaviors Questionnaire-Revised) in a sample of 632 trauma-exposed firefighters (93.5% men; Mage = 38.44 years, SD = 8.59). Hierarchical logistic regression analyses evaluated whether the main and interactive effects of PTSD symptom severity and alcohol use disorders were significantly related to suicide risk, above and beyond age and cumulative trauma. The main effects of PTSD symptom severity (odds ratio, 1.76; p0.001) and alcohol use problems (odds ratio, 1.37; p = 0.391) significantly positively predicted suicide risk; however, PTSD symptoms did not moderate an association between alcohol use problems and suicide risk after accounting for these main effects (p0.05). A secondary, exploratory aim demonstrated that all PTSD symptom clusters significantly positively predicted suicide risk (p's0.001), although none of these clusters interacted with alcohol use problems to predict suicide risk (p's0.05). Theoretical and clinical implications are discussed as they relate to the importance of screening for PTSD and alcohol use disorder among firefighter populations.

Prospective intolerance of uncertainty (IU) involves fear and anxiety in anticipation of future uncertainty and is especially related to worry and generalized anxiety disorder (GAD). Individuals high in IU appraise uncertain situations as threatening and thus may engage in excessive information-seeking behavior to decrease uncertainty. This study aimed to examine the links between prospective IU and information-seeking. Participants (N = 174) high and low in prospective IU completed an ostensible aptitude test (threat stimulus), which was supposedly either excellent (high relevance condition) or poor (low relevance condition) at predicting future outcomes. Thus, the test itself presented an immediate threat, and the awaited test results generated uncertainty. Following the relevance manipulation, participants were given the opportunity to engage in information-seeking behavior by asking questions about the ostensible test and by requesting feedback about the test results. Results indicated that in the high-relevance condition, individuals high and low in IU evidenced similar levels of information-seeking behavior. Conversely, in the low-relevance condition, individuals low in IU evidenced less information-seeking than did individuals high in IU. Furthermore, cognitive appraisals of ambiguous situations were associated with the extent of information-seeking behavior. The implications of these findings for the treatment of GAD are discussed.

Firefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters.Participants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items-experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years-were considered high in cardiovascular risk.A structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p .01) and depression symptoms (β = 0.32, p .01); lower DT was associated with greater PTSD (β = -0.18, p .01) and depression symptoms (β = -0.31, p .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p .01]; low cardiovascular risk group: β = 0.33, p .01).High cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.

OBJECTIVE Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur, with elevated rates of both disorders in lesbian, gay, or bisexual (LGB) samples. Few studies have compared the strength of PTSD-AUD associations between LGB and heterosexual individuals or evaluated the role of nontraumatic LGB discrimination in these relationships among sexual minorities. METHOD The current study utilized nationally representative epidemiological data (N = 29,646) to (a) examine whether associations between lifetime trauma endorsement/PTSD and lifetime alcohol dependence (AD) differ as a function of sexual minority status and (b) evaluate the role of LGB-specific discrimination in trauma/PTSD and AD associations among LGB individuals. RESULTS Logistic regression analyses showed the association between lifetime trauma endorsement and lifetime AD was significantly greater in magnitude for LGB individuals (odds ratio [OR] = 2.17) compared to heterosexual individuals (OR = 1.32; Z = 2.51, p .05), after controlling for trauma endorsement. Among the LGB subsample, logistic regression analyses did not support a significant main effect for LGB discrimination nor an interaction between trauma endorsement and nontraumatic LGB discrimination, nor between PTSD and nontraumatic LGB discrimination, on lifetime AD (ps > .05). CONCLUSIONS LGB individuals demonstrate stronger associations between lifetime trauma endorsement and AD, relative to heterosexual counterparts; however, this association may not be accounted for or moderated by nontraumatic LGB discrimination. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

This experimental training study examined which of three brief online cognitive reappraisal training protocols best enhances well-being and emotion regulation in response to stressful events. Participants were randomly assigned to learn positive reframing, self-distancing, or temporal distancing, and were asked to practice these techniques in their daily lives as interpersonal stressors arose naturally. The control group was instructed to continue regulating their emotions as they naturally would. Compared to the control, all training groups showed decreased negative emotional reactivity to the visualization of a recent stressful event 2 weeks post-training. They also showed a significant increase in general well-being from baseline to post-training. Participants’ change in reappraisal accounted for the training groups’ increased well-being.

Background and objectives Research indicates that greater variability in affect and emotion over time is associated with depression and anxiety. However, it remains unclear whether individuals with generalized anxiety disorder (GAD) experience greater affect variability due to individual differences or differences in the stimuli they encounter. The current study investigated whether individuals with analogue GAD demonstrate greater affect variability in response to a standardized set of stimuli. Methods: Participants were 134 (95 female) undergraduate participants with analogue GAD (endorsing DSM-IV criteria A, B, C, and E on the GAD-Q-IV; n = 66) or with no symptoms of GAD (n = 68). Participants reported affective reactions (positive affect, negative affect, affective arousal, and affective dominance) to each of nine sets of standardized images varying in valence (positive, neutral, or negative) and arousal (low, medium, or high). Results: In a logistic regression model controlling for baseline measurements, higher variability of affective arousal across the nine sets of images uniquely predicted analogue GAD status, whereas variability in positive affect, negative affect, and affective dominance did not. Additional analyses revealed that lower mean affective arousal also uniquely predicted analogue GAD. Limitations: Limitations include using self-report measures to determine analogue GAD status; using a short laboratory session for the assessment of affect variability; and potential repeated testing effects. Conclusions: These findings suggest that individuals with GAD symptoms experience higher levels of affective arousal variability, even when the stimuli presented are held constant. Assessing variability in affective arousal may be helpful in both conceptualizing and treating individuals with GAD symptoms.