PTSD, AUD, and Interpersonal Conflict: Within-person associations

总结 该应用程序旨在创新性地模拟创伤后应激障碍症状（PTSS），酒精使用 在250名OIF/OEF/OND退伍军人的样本中， 关于调节缺陷、睡眠障碍和内隐方法的作用的综合影响， 回避偏见参与者将被随机分配到认知偏差修正（CBM）训练条件下， 2（酒精CBM，对照）× 2（PTSD CBM，对照）设计。纵向爆破设计将导致高 对AUD、PTSS、人际冲突和情感缺陷进行近实时评估的保真度数据集， 在两年的时间里进行行为规范。将通过体动记录仪评估睡眠障碍。的 本申请涉及三个相关问题。首先，什么过程链接（PTSS），AUD症状， 人与人之间的冲突（即，每日）水平？我们建议，急剧变化（例如，日常） 在情绪和行为失调是两个途径连接PTSS，AUD症状，和人际 人与人之间的冲突。第二，是什么促成了PTSS和 AUD结果？饮酒对睡眠质量有很好的负面影响。睡眠障碍是一种 创伤后应激障碍的常见症状，并损害情绪和行为调节。睡眠障碍可以解释 观察到双向关联。第三，为什么情绪唤醒和去抑制的状态变化 AUD症状增加反映了对酒精摄入的控制受损？内隐反应偏差 概念化为一种潜在的风险因素，在自我调节受损时对行为的影响最大。 我们认为，与急性（即，PTSS 加剧导致内隐过程对行为的影响增加。因此，内隐偏见对 行为随时间和环境而变化。酗酒者对酒精和性行为表现出接近偏见 创伤受害者表现出对创伤线索的回避偏见，这与创伤后应激障碍的严重程度有关。的 对隐性偏倚的实验操作与纵向突发设计随访配对，将检验 随着时间的推移，内隐反应偏差与PTSS和结果有关。我们假设操纵 适应不良反应偏差将减少PTSS，情感和行为之间的人内关联 失调，睡眠障碍，以及酒精相关的结果。申请的科学前提是 通过对实证文献和支持的优秀试点数据进行充分知情和平衡的审查， 的假设。本实验设计，多点取样，经验取样方案，精密 数据分析策略有助于对假设进行高度严格的检验。拟议项目将 内隐认知、睡眠障碍、情感失调和行为去抑制研究进展 理解创伤应激、AUD和人际冲突之间的功能关联。本研究 将对该领域对PTSD和AUD共病的潜在机制的理解产生重大影响。

Summary This application seeks to innovatively model the dynamic course of PTSD symptoms (PTSS), alcohol use disorder (AUD), and interpersonal conflict in a sample of 250 OIF/OEF/OND veterans and test hypotheses regarding combined effects of regulatory deficits, sleep disturbance, and the role of implicit approach / avoidance biases. Participants will be randomized to a cognitive bias modification (CBM) training condition in a 2 (Alcohol CBM, Control) x 2 (PTSD CBM, Control) design. The longitudinal burst design will result in a high fidelity dataset of near real-time assessments of AUD, PTSS, interpersonal conflict, and deficits in affect and behavior regulation over the course of 2 years. Sleep disturbance will be assessed by actigraphy. The application addresses three related questions. First, what processes link (PTSS), AUD symptoms, and interpersonal conflict at the within-person (i.e., daily) level? We propose that acute changes (e.g., day-to-day) in emotional and behavioral dysregulation are two pathways linking PTSS, AUD symptoms, and interpersonal conflict at the within-persons level. Second, what contributes to reciprocal associations between PTSS and AUD outcomes? Alcohol use has well-documented negative effects on sleep quality. Sleep disturbance is a common symptom of PTSD and impairs emotional and behavior regulation. Sleep disturbance may explain observed bi-directional associations. Third, why do state changes in emotional arousal and disinhibition increase symptoms of AUD reflecting impaired control over alcohol intake? Implicit response biases are conceptualized as a latent risk factor that influences behavior most strongly when self-regulation is impaired. We propose that heightened emotional arousal and disinhibition associated with acute (i.e., daily) PTSS exacerbation result in an increased effect of implicit processes on behavior. Hence, effects of implicit biases on behavior vary across time and context. Heavy drinkers exhibit approach biases for alcohol and sexual trauma victims exhibit avoidance biases toward trauma cues, which are related to PTSD severity. The experimental manipulation of implicit biases paired with the longitudinal burst design follow-up will test whether implicit response biases are related to PTSS and outcomes over time. We hypothesize that manipulating maladaptive response biases will reduce within-person associations between PTSS, affect and behavioral dysregulation, sleep disturbance, and the alcohol-related outcomes. The scientific premise of the application is bolstered by a well-informed and balanced review of the empirical literature and excellent pilot data supporting the hypotheses. The experimental design, multi-site sample, experience sampling protocol, and sophisticated data analytic strategy contribute to a highly rigorous test of the hypotheses. The proposed project integrates the study of implicit cognition, sleep disturbance, affect dysregulation, and behavioral disinhibition to advance understanding of functional associations between traumatic stress, AUD, and interpersonal conflict. This study will have high impact on the field’s understanding of mechanisms underlying PTSD and AUD comorbidity.