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

摘要 这个应用程序试图创新性地模拟创伤后应激障碍症状(PTSS)、酒精使用的动态过程 250名退伍军人的精神障碍(AUD)、人际冲突和检验假设 关于调节缺陷、睡眠障碍和隐性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(酒精煤层气，对照)×2(PTSD煤层气，对照)设计。纵向爆破设计将产生较高的 对澳元、PTSS、人际冲突和情感缺陷的近实时评估的保真度数据集 2年内的行为规范。睡眠障碍将通过动作记录仪进行评估。这个 应用程序解决了三个相关的问题。首先，哪些流程与PTSS、AUD症状和 人与人之间(即日常)的人际冲突？我们认为，剧烈的变化(例如，日常变化) 在情绪和行为失调中，有两条途径将PTSS、AUD症状和人际关系联系起来 人与人之间的冲突。第二，是什么促成了PTSS和PTSS之间的互惠联系 AUD结果如何？饮酒对睡眠质量的负面影响是有据可查的。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。睡眠障碍或许可以解释 观察到双向关联。第三，为什么情绪唤醒和去抑制的状态会发生变化 AUD症状增加，反映出对酒精摄入量的控制受损？内隐反应偏向是 被概念化为当自我调节受损时对行为影响最大的潜在风险因素。 我们认为高度的情绪唤醒和去抑制与急性(即日常)PTSS相关 加剧会导致内隐过程对行为的影响增加。因此，内隐偏向对 行为因时间和背景而异。酗酒者在酒精和性方面表现出偏向 创伤受害者对创伤线索表现出回避偏向，创伤线索与创伤后应激障碍的严重程度有关。这个 对内隐偏差的实验操作与纵向爆破设计的后续研究将检验 内隐反应偏差与创伤后应激障碍和随时间推移的结果有关。我们假设操控 适应不良反应偏差将减少PTSS、情感和行为之间的人内联系 调节失调，睡眠障碍，以及与酒精相关的后果。应用的科学前提是 由对经验文献的充分了解和平衡审查以及出色的试验数据支持 假设。本实验设计，多点采样，经验采样方案，精良 数据分析策略有助于对假设进行高度严格的测试。拟议的项目整合了 内隐认知、睡眠障碍、情绪调节障碍和行为去抑制的研究进展 了解创伤应激、创伤后应激障碍和人际冲突之间的功能联系。本研究 将对该领域对创伤后应激障碍和澳门氏症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.