Emotional engagement and relapse to alcohol use in a trauma-exposed sample

描述(申请人提供)：创伤后应激障碍(PTSD)和酒精使用障碍(AUD)经常同时发生，这是一个令人担忧的问题，因为与只有AUD的人相比，患有PTSD和AUD的人在治疗后更具治疗抵抗力，更容易复发物质。这种关系可以通过假设患有创伤后应激障碍和AUD的人使用酒精来应对令人痛苦的创伤后应激障碍症状的理论来解释。创伤后应激障碍的理论表明，情绪投入或唤起与创伤记忆相关的关键情绪体验，是解决创伤后应激障碍症状的关键。然而，与创伤相关的症状和情绪在治疗AUD时往往没有得到解决。因此，缺乏情感投入可能会导致酒精复发，在这个循环中，未解决的创伤后应激障碍症状保持着对酒精的渴望和使用。鉴于AUDS与PTSD并存时的治疗难治性，了解解释PTSD症状如何导致酒精复发以及我们如何最好地干预这一人群的潜在机制具有重要的临床意义。这项研究的总体目标是检查在治疗AUD期间情绪参与与创伤记忆的关系，作为治疗后减少再次饮酒的预测因素。更具体地说，这项拟议的研究将调查情感投入与创伤记忆和自我报告的酒精渴望之间的直接关系，以及在AUD治疗后3个月时自我报告的酒精渴望和复发之间的关系，以及这些应对信念是否在情感参与、酒精渴望和酒精复发之间起中介作用。这项研究将招募100名目前正在接受酒精依赖治疗的女性，她们同时有创伤病史和创伤后应激障碍的症状。评估将在治疗前、治疗后和3个月的随访时间点进行。为了探索研究目的，情绪投入将通过三个环节的记叙性写作作业来操纵，旨在引发情绪投入与记忆，并将使用自我报告和编码测量来评估情绪投入水平。此外，还将考察有关容忍创伤相关痛苦的能力的信念，以及应对饮酒、渴望和复发的动机。总体而言，这项研究试图更好地了解患有创伤后应激障碍和AUD的女性再次饮酒的机制，并有可能为这一难以治疗的人群确定重要的干预目标。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) co-occur frequently which is a concern given that individuals with PTSD and AUD are more treatment resistant and prone to substance relapse following treatment compared to individuals with only AUD. This relationship may be explained by theories positing that individuals with PTSD and AUD use alcohol to cope with distressing PTSD symptoms. Theories of PTSD suggest that emotional engagement, or evoking key emotional experiences related to the trauma memory, is crucial in resolving PTSD symptoms. However, trauma-related symptoms and emotions are often not addressed in treatment for AUD. Thus, lack of emotional engagement may contribute to alcohol relapse through a cycle where unresolved PTSD symptoms maintain alcohol cravings and use. Given the treatment refractory nature of AUDs when comorbid with PTSD, understanding underlying mechanisms explaining how symptoms of PTSD may contribute to alcohol relapse and how we may best intervene with this population is of great clinical importance. The overall goal of this study is to examine emotional engagement with the trauma memory during treatment for AUD as a predictor of decreased relapse to alcohol use following treatment. More specifically, the proposed research will investigate the direct relationship between emotional engagement with the trauma memory and self-reported alcohol cravings and relapse at 3-months post-treatment for AUD, the relationship between beliefs about ability to tolerate trauma-related emotions, coping motives for alcohol use and self-reported alcohol cravings and relapse at 3-months post-treatment for AUD, and whether these coping beliefs mediate the relationship between emotional engagement, alcohol cravings, and relapse to alcohol use. This study will enroll 100 women currently in treatment for alcohol dependence with co-occurring trauma histories and symptoms of PTSD. Assessments will be conducted at pre-treatment, post-treatment, and at 3-month follow-up time points. In order to explore study aims, emotional engagement will be manipulated through a three session narrative writing assignment designed to elicit emotional engagement with the memory and level of emotional engagement will be assessed with both self-report and coding measures. In addition, beliefs about ability to tolerate trauma-related distress and coping motives for alcohol use as well as cravings and relapse will be examined. Overall, this study seeks to better understand mechanisms of relapse to alcohol use in women with PTSD and AUD, and has the potential to identify important intervention targets for this difficult to treat population.