Examining the Effect of Sleep Disruption on Emotion Regulation and Trauma-Related Symptoms in Veterans

检查睡眠中断对退伍军人情绪调节和创伤相关症状的影响

• 批准号: 10417019
• 负责人: Laura D Straus
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10417019
• 关键词: Acute; Affective; Biological Process; Clinical; Cohort Studies; Cross-Sectional Studies; Data Reporting; Development; Diagnostic; Disease; Distress; Emotional; Emotions; Evidence based treatment; Goals; Gold; Image; Impaired cognition; Impairment; International; Intervention; Laboratories; Link; Literature; Longitudinal Studies; Maintenance; Measures; Mental Health; Methods; Modeling; Nightmare; Participant; Patient Self-Report; Patients; Pharmacology; Post-Traumatic Stress Disorders; Process; Questionnaires; REM Sleep; REM Sleep Deprivations; Randomized; Recording of previous events; Reporting; Research; Research Personnel; Risk Factors; Role; Sampling; Severities; Sleep; Sleep Deprivation; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Sleeplessness; Slow-Wave Sleep; Stimulus; Symptoms; System; Testing; Time; Training; Trauma; Validation; Veterans; active control; base; career; cognitive reappraisal; cohort; design; effective intervention; emotion regulation; evidence base; experimental study; imaging system; indexing; longitudinal analysis; modifiable risk; physical conditioning; poor sleep; post-traumatic symptoms; psychosocial; recruit; response; sleep quality; sleep regulation; trauma exposure

Posttraumatic Stress Disorder (PTSD) is common in Veterans and associated with a number of negative physical and mental health consequences. While evidence-based pharmacological and psychosocial interventions for PTSD have been developed, not all patients respond fully to treatment. Investigating the biological processes involved in the development and maintenance of PTSD will increase understanding of the disorder and aid in the development of more effective interventions. Sleep disruption, particularly Rapid Eye Movement (REM) sleep disruption, is a potent and modifiable risk factor contributing to PTSD. For example, longitudinal studies have shown REM sleep fragmentation in the acute aftermath of trauma predicts PTSD symptoms at a later timepoint, underscoring the potential importance of sleep as a mechanism in PTSD. Recent research has also demonstrated an association between poor sleep and impaired emotion regulation. Specifically, research suggests disrupted sleep impairs effective emotion regulation strategies, such as cognitive reappraisal, while increasing reliance on more maladaptive emotion regulation strategies, such as expressive suppression. For example, previous studies have shown poor sleep at baseline predicts impaired cognitive reappraisal in lab-based tasks involving emotionally provocative stimuli. Our research group has also demonstrated that poor self-reported global sleep quality is associated with reduced cognitive reappraisal and increased reliance on expressive suppression when measured at one timepoint in a large group of Veterans with and without PTSD. The implications of this finding are particularly salient for patients with PTSD, because maladaptive emotion regulation contributes to severity of trauma-related symptoms, increases distress, and interferes with gold-standard interventions for PTSD. However, most research linking disrupted sleep to impaired emotion regulation has been conducted in healthy controls, or at only one time-point in clinical samples. Therefore, additional research is necessary to provide support for a hypothesized model whereby disrupted sleep contributes to maladaptive emotion regulation, thus in turn maintaining trauma-related symptoms. This study responds to these gaps in the literature by using both self-report longitudinal measures and an experimental sleep manipulation to test the hypothesis that disrupted sleep contributes to maladaptive emotion regulation in Veterans with and without PTSD. The first aim of the study will be to examine whether poor sleep at one timepoint predicts maladaptive emotion regulation and trauma-related symptoms at subsequent timepoints in a large cohort of Veterans with and without PTSD. The Insomnia Severity Index (ISI), the Emotion Regulation Questionnaire (ERQ), and the PTSD Checklist (PCL) will be measured at three timepoints in this cohort. We hypothesize that poor sleep at the first timepoint will predict reduced reappraisal, increased expressive suppression, and increased severity of trauma-related symptoms at the subsequent timepoints. The second portion of the proposed project will build upon these findings by experimentally testing the notion that disrupted sleep results in impaired emotion regulation, and will also directly test the hypothesis that REM sleep specifically is tied to emotion regulation processes. A sample of Veterans (n = 60) with and without PTSD will be recruited and randomized to undergo one of three sleep conditions: 1) one night of REM sleep deprivation (REMD), 2) one night of slow-wave sleep deprivation (SWSD, an active control condition), or 3) one night of normal sleep. Participants will then participate in two laboratory emotion reappraisal tasks using images from the International Affective Picture System (IAPS). We hypothesize that participants in the REMD group will rate the images more negatively during a cognitive reappraisal task than SWSD group or the normal sleep group, and will also be more likely to choose expressive suppression than reappraisal on an emotion regulation choice task. Exploratory analyses will determine if this effect differs by diagnostic group status.

创伤后应激障碍（PTSD）在退伍军人中很常见，并与许多负面影响有关 身体和心理健康的后果。虽然基于证据的药理学和心理社会 针对 PTSD 的干预措施已经制定，但并非所有患者都对治疗完全有效。调查 PTSD 的发展和维持所涉及的生物过程将增加对 紊乱并帮助制定更有效的干预措施。睡眠中断，尤其是Rapid Eye 运动（REM）睡眠中断是导致创伤后应激障碍（PTSD）的一个有效且可改变的危险因素。例如， 纵向研究表明，创伤后急性期快速眼动睡眠的碎片化可预测创伤后应激障碍 (PTSD) 稍后时间点的症状，强调了睡眠作为 PTSD 机制的潜在重要性。 最近的研究还证明睡眠不佳与情绪调节受损之间存在关联。 具体来说，研究表明睡眠中断会损害有效的情绪调节策略，例如 认知重新评估，同时增加对适应不良的情绪调节策略的依赖，例如 表达性抑制。例如，之前的研究表明，基线睡眠不佳预示着身体受损 涉及情绪刺激的实验室任务中的认知重新评估。我们的研究小组还 证明自我报告的整体睡眠质量不佳与认知重新评估的减少和 在一大群退伍军人的一个时间点进行测量时，对表达抑制的依赖增加 有或没有 PTSD。这一发现对于患有创伤后应激障碍（PTSD）的患者来说尤其重要，因为 适应不良的情绪调节会导致创伤相关症状的严重程度，增加痛苦， 干扰 PTSD 的黄金标准干预措施。然而，大多数研究将睡眠中断与 情绪调节受损已在健康对照中进行过，或仅在临床的一个时间点进行过 样品。因此，有必要进行额外的研究来为假设模型提供支持，其中 睡眠中断会导致适应不良的情绪调节，从而维持与创伤相关的情绪 症状。本研究通过使用自我报告纵向测量来回应文献中的这些差距 以及一项实验性睡眠操纵，以检验睡眠中断会导致适应不良的假设 有或没有 PTSD 的退伍军人的情绪调节。该研究的首要目的是检验是否 某个时间点的睡眠不佳预示着情绪调节不良和创伤相关症状 对一大群患有或不患有创伤后应激障碍 (PTSD) 的退伍军人进行的后续时间点研究。失眠严重程度指数（ISI）， 情绪调节问卷（ERQ）和创伤后应激障碍（PTSD）检查表（PCL）将在三点进行测量 该队列中的时间点。我们假设第一个时间点的睡眠不佳将预测重新评估的减少， 表达抑制增加，随后创伤相关症状的严重程度增加 时间点。拟议项目的第二部分将通过实验测试建立在这些发现的基础上 睡眠中断会导致情绪调节受损的观点，也将直接检验该假设 快速眼动睡眠与情绪调节过程密切相关。退伍军人样本 (n = 60) 具有 和 没有 PTSD 的人将被招募并随机接受以下三种睡眠条件之一：1) 一晚快速眼动睡眠 睡眠剥夺 (REMD)，2) 一晚慢波睡眠剥夺（SWSD，主动控制条件），或 3）一晚正常睡眠。然后，参与者将使用以下方法参与两项实验室情绪重新评估任务： 来自国际情感图片系统（IAPS）的图像。我们假设 REMD 的参与者 在认知重新评估任务中，与 SWSD 组或正常组相比，该组对图像的评价更负面 睡眠组，也更有可能选择表达抑制而不是重新评估情绪 调节选择任务。探索性分析将确定这种效应是否因诊断组状态而异。