Daily State-like Distress Tolerance and Alcohol Use Motivation among Hazardous Drinkers with Posttraumatic Stress Disorder

项目摘要/摘要 危险饮酒和创伤后应激障碍(PTSD)是非常普遍和频繁的 共同的公共卫生状况导致比任何一个更严重的临床和功能后果 个人混乱12胜17负。目前还没有“黄金标准”的循证治疗方法。 18此外，对这一人群最有希望的干预措施的特点是高发病率 减员和治疗效果小19，使这一群体得不到足够的服务，缺乏强有力的临床 重大干预20.一些研究表明，痛苦耐受性(DT)的个体差异是 理论上与危险饮酒和PTSD21-25有关。DT反映了感知的或客观的能力 能承受负面的情感或身体状态26.DT相对稳定(即具有类似性状的品质)，但最近 工作表明，它还保持了类似状态的性质27、28。状态类DT是一个心理过程，表现为 随着时间的推移，反复地、连续地。过去的工作没有在创伤后应激障碍和创伤后应激障碍方面整合状态样的DT 危险饮酒共病。填补这一空白，促进能够为未来提供信息的机械性知识 对于这一人群的治疗开发，拟议的研究将检查以下主要目标 21天时间采样时期的生态瞬时评估(EMA)框架： 状态样低DT是否在基线PTSD症状和饮酒之间起中介作用 动机；以及状态样DT是否在基线的PTSD症状和 危险饮酒。这个项目的主要假设是，较低的状态类dt将调节 在A.1.a中列出的基线PTSD症状与酒精结果之间的关系。和A.2.a.在寻求 识别和理解状态样DT作为一种可能低于酒精使用和共生的作用机制 条件(例如，创伤后应激障碍)，这项提案涉及国家酒精滥用和酒精中毒研究所 (NIAAA)战略规划目标(目标1a)。该奖项将支持研究方法方面的重点培训。 和统计分析，否则是不可能的，并提供了进行 研究旨在加深对状态样DT作为影响创伤后应激障碍的潜在机制的理解 有害酒精使用协会。

PROJECT SUMMARY/ABSTRACT Hazardous drinking and posttraumatic stress disorder (PTSD) are both highly prevalent and frequently comorbid public health conditions that result in more severe clinical and functional outcomes than either individual disorder12-17. There are currently no “gold standard,” evidence-based treatments available for this comorbidity.18 Moreover, the most promising interventions for this population are marked by high rates of attrition and small treatment effect sizes19, leaving this group underserved and lacking a robust and clinically significant intervention20. Some research suggests that individual differences in distress tolerance (DT) are theoretically relevant to both hazardous drinking and PTSD21-25. DT reflects the perceived or objective ability to withstand negative affective or bodily states26. DT is relatively stable (i.e., it has trait-like qualities), but recent work indicates that it also maintains state-like qualities27, 28. State-like DT is a psychological process expressed repeatedly and continuously over time29. Past work has not integrated state-like DT in terms of PTSD and hazardous drinking comorbidity. To fill this gap and facilitate mechanistic knowledge that can inform future treatment development for this population, the proposed research will examine the following primary aims in an ecological momentary assessment (EMA) framework over a 21-day time-sampling epoch: to examine whether state-like lower DT mediates the association between PTSD symptoms at baseline and alcohol use motivation; and whether state-like DT mediates the association between PTSD symptoms at baseline and hazardous drinking. The primary hypothesis of this project is that lower state-like DT will mediate the association between baseline PTSD symptoms and alcohol outcomes listed in A.1.a. and A.2.a. In seeking to identify and understand state-like DT as a mechanism of action that may underly alcohol use and co-occurring conditions (e.g., PTSD), this proposal addresses the National Institute of Alcohol Abuse and Alcoholism (NIAAA) strategic planning goals (Objective 1a). This award will support focused training in research methods and statistical analysis that would not otherwise be possible, as well as provide the opportunity to conduct research to develop a greater understanding of state-like DT as a potential mechanism influencing PTSD- hazardous alcohol use associations.