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Leone RM, Jarnecke AM, Gilmore AK, Flanagan JC. Alcohol use problems and conflict among couples: A preliminary investigation of the moderating effects of maladaptive cognitive emotion regulation strategies. COUPLE & FAMILY PSYCHOLOGY 2022; 11:290-299. [PMID: 36438780 PMCID: PMC9697959 DOI: 10.1037/cfp0000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Alcohol use can operate as a chronic relationship stressor with adverse influences on individual and relationship functioning, including negative conflict behaviors; however, it remains unclear what modifiable individual-level factors may moderate this association. The current study examined the effects of maladaptive cognitive emotion regulation strategies on the relation between alcohol use problems and negative relationship conflict behaviors. Participants were 30 couples (N=60) wherein at least one partner engaged in recent hazardous drinking or illicit drug use. Participants completed a measure of maladaptive cognitive emotion regulation strategies (i.e., catastrophizing, self-blame, blaming others, rumination) and engaged in a 10-minute dyadic conflict task in the laboratory. Couple conflict behaviors were video-recorded and assessed using a validated coding system. Actor partner interdependence models indicated that (1) men with more maladaptive cognitive emotion regulation strategies displayed more negative relationship conflict behaviors and (2) among women who use fewer maladaptive cognitive emotion regulation strategies, those who report alcohol use problems display more negative relationship behaviors than women who report fewer alcohol use problems. These findings suggest that the tendency to engage in fewer maladaptive cognitive emotion regulation strategies buffers the effect of conflict among women without alcohol use problems. Results also suggest that women with alcohol use problems engaged in more negative conflict behaviors regardless of their tendency to use maladaptive cognitive emotion regulation strategies. This research has important implications for integrating emotion regulation skills into alcohol use treatment for women, particularly later in the course of treatment.
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Affiliation(s)
- Ruschelle M. Leone
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
- Center for Interpersonal Violence, Georgia State University
| | - Amber M. Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Amanda K. Gilmore
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
- Center for Interpersonal Violence, Georgia State University
| | - Julianne C. Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
- Ralph H. Johnson VA Medical Center
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2
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Altman BR, Braun TD, Battle CL, Iacoi S, Stein MD, Abrantes AM. The indirect effect of negative emotionality via alcohol craving on abstinence self-efficacy among women in alcohol treatment. Addict Behav 2022; 132:107347. [PMID: 35561632 PMCID: PMC10260287 DOI: 10.1016/j.addbeh.2022.107347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 01/26/2023]
Abstract
Women with alcohol use disorder (AUD) often present to treatment with heightened negative emotionality, including negative affect, anxiety, stress, and depression. Negative emotionality might impact women's alcohol abstinence self-efficacy (AASE), or confidence in their ability to remain sober, which is an important predictor of treatment outcomes. It is also plausible that other variables, such as alcohol craving, influence AASE. The present work examined the indirect effect of negative emotionality on AASE via alcohol craving as a mediator cross-sectionally among a sample of women enrolled in AUD treatment reporting co-occurring depressive symptoms (N = 73). Participants completed baseline measures of negative emotionality (e.g. anxiety and depression symptoms, stress, negative affect), alcohol craving, and AASE. All indices of negative emotionality were positively correlated with each other and alcohol craving (r's ranging from 0.244 to 0.671) and all but depression were inversely associated with AASE (r's ranging from -0.341 to -0.234; p <.05). In separate simple mediation models, we found that alcohol craving mediated the association of each of the four measures of negative emotionality with AASE. Further longitudinal and experimental work is necessary to determine if teaching skills to cope with alcohol craving in the context of co-occurring negative emotionality might lead to better therapeutic outcomes.
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Affiliation(s)
- Brianna R Altman
- Alpert Medical School of Brown University, Providence, RI, United States
| | - Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States
| | - Cynthia L Battle
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States; Women & Infants Hospital of Rhode Island, Providence, RI, United States
| | | | | | - Ana M Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States.
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Muhammad Sohail M, Yao J, Evon DM, Muir AJ, Proeschold-Bell RJ. Change in Alcohol Use and Association with Positive and Negative Emotions: Results from an Alcohol Treatment Study with Hepatitis C Patients. ALCOHOLISM TREATMENT QUARTERLY 2021; 39:430-445. [PMID: 34712005 DOI: 10.1080/07347324.2020.1868957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Few studies exist on the change over time in positive and negative emotions during treatment for alcoholism disorders. We aimed to evaluate relationship between alcohol reduction and change in positive and negative emotions. Chronic HCV patients (n=174) with alcohol use received brief alcohol counseling. Participants completed the PANAS-Short Form, MHC-Short Form, and the Alcohol Timeline Follow back at baseline and 3, 6, and 12 months. Decreases in alcohol use were related to decreased negative emotions from baseline to 3 months, baseline to 6 months and baseline to 12 months. Decreases in alcohol use were associated with increased positive emotions from baseline to 12 months but not sooner.
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Affiliation(s)
| | - Jia Yao
- Duke Center for Health Policy & Inequalities Research, Duke Global Health Institute
| | - Donna M Evon
- Department of Medicine, The University of North Carolina at Chapel Hill
| | - Andrew J Muir
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Duke Clinical Research Institute, DUMC 3913, Durham, NC 27710, USA
| | - Rae Jean Proeschold-Bell
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, (919) 613-5442, 310 Trent Drive, Room 310, Durham, NC 27708, Box 90392, Durham, NC 27708
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Mathersul DC, Dixit K, Avery TJ, Schulz-Heik RJ, Zeitzer JM, Mahoney LA, Cho RH, Bayley PJ. Heart rate and heart rate variability as outcomes and longitudinal moderators of treatment for pain across follow-up in Veterans with Gulf War illness. Life Sci 2021; 277:119604. [PMID: 33984356 DOI: 10.1016/j.lfs.2021.119604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS Accumulating evidence suggests Gulf War illness (GWI) is characterised by autonomic nervous system dysfunction (higher heart rate [HR], lower heart rate variability [HRV]). Yoga - an ancient mind-body practice combining mindfulness, breathwork, and physical postures - is proposed to improve autonomic dysfunction yet this remains untested in GWI. We aimed to determine (i) whether HR and HRV improve among Veterans with GWI receiving either yoga or cognitive behavioural therapy (CBT) for pain; and (ii) whether baseline autonomic functioning predicts treatment-related pain outcomes across follow-up. MAIN METHODS We present secondary analyses of 24-hour ambulatory cardiac data (mean HR, square root of the mean squared differences between successive R-R intervals [RMSSD], high frequency power [HF-HFV], and low-to-high frequency ratio [LF/HF] extracted from a 5-min window during the first hour of sleep) from our randomised controlled trial of yoga versus CBT for pain among Veterans with GWI (ClinicalTrials.govNCT02378025; N = 75). KEY FINDINGS Veterans who received CBT tended towards higher mean HR at end-of-treatment. Better autonomic function (lower mean HR, higher RMSSD/HF-HRV) at baseline predicted greater reductions in pain across follow-up, regardless of treatment group. Better baseline autonomic function (mid-range-to-high RMSSD/HF-HRV) also predicted greater pain reductions with yoga, while worse baseline autonomic function (higher mean HR, lower RMSSD/HF-HRV) predicted greater pain reductions with CBT. SIGNIFICANCE To our knowledge, this is the first study to suggest that among Veterans with GWI, HR may increase with CBT yet remain stable with yoga. Furthermore, HR and HRV moderated pain outcome across follow-up for yoga and CBT.
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Affiliation(s)
- Danielle C Mathersul
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; Discipline of Psychology, Murdoch University, Murdoch, WA 6150, Australia.
| | - Kamini Dixit
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Timothy J Avery
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; National Centre for Posttraumatic Stress Disorder (NCPTSD), Veterans Affairs Menlo Park Health Care System, Menlo Park, CA 94025, United States of America
| | - R Jay Schulz-Heik
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Louise A Mahoney
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Rachael H Cho
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America
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Mechler J, Lindqvist K, Falkenström F, Carlbring P, Andersson G, Philips B. Sudden gains and large intersession improvements in internet-based psychodynamic treatment (IPDT) for depressed adolescents. Psychother Res 2020; 31:455-467. [PMID: 32799772 DOI: 10.1080/10503307.2020.1804084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: Sudden gains (SGs) have often been found associated with better treatment outcome across different psychiatric disorders. However, no studies have evaluated SGs in internet-based treatment targeting adolescent depression. Method: The sample consisted of 66 adolescents diagnosed with major depressive disorder, attending psychodynamic internet-based treatment. Effects of SGs were evaluated at posttreatment and 6-month follow-up. We also evaluated effects of large intersession improvements (LIIs; sudden and relatively large gains, between sessions, without the stability criterion). Effects of SGs and LIIs early in treatment were also investigated. Results: A total of 17 patients (25.75%) experienced an SG. The effect of having an SG or early SG was non-significant after treatment (d = 0.48) and at follow-up (d = 0.66). However, having an LII was related to better outcome after treatment (d = 0.97) and at follow-up (d = 0.76). Early LIIs were associated with significantly better results at end of treatment (d = 0.72). Conclusions: The original criteria of SGs might be overly conservative and thus miss important improvements in depression. Relatively large intersession gains, regardless of stability, seem to be predictive of outcome.
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Affiliation(s)
- Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Abstract
Women with alcohol use disorder (AUD) experience more barriers to AUD treatment and are less likely to access treatment than men with AUD. A literature review identified several barriers to women seeking help: low perception of a need for treatment; guilt and shame; co-occurring disorders; employment, economic, and health insurance disparities; childcare responsibilities; and fear of child protective services. Women entering treatment present with more severe AUD and more complex psychological, social, and service needs than men. Treatment program elements that may reduce barriers to AUD treatment include provision of childcare, prenatal care, treatment for co-occurring psychological problems, and supplemental social services. Research has suggested that outcomes for women are best when treatment is provided in women-only programs that include female-specific content. To date, research on treatments tailored to the individual needs of women is limited, but research on mechanisms of change has suggested the importance of targeting anxiety and depression, affiliative statements in treatment, abstinence self-efficacy, coping skills, autonomy, and social support for abstinence. Future research should focus on early interventions, linkages between primary care or mental health clinics and AUD treatment settings, and integrated treatments for co-occurring AUD and other disorders. Further research should also explore novel treatment delivery approaches such as digital platforms and peer support groups.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kathryn F Fokas
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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Swan JE, Votaw VR, Stein ER, Witkiewitz K. The Role of Affect in Psychosocial Treatments for Substance Use Disorders. CURRENT ADDICTION REPORTS 2020; 7:108-116. [PMID: 34327114 PMCID: PMC8317473 DOI: 10.1007/s40429-020-00304-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This paper provides a narrative review of studies published over the past five years that have examined the role of affect, including both affective symptoms and affective disorders, in psychosocial treatments for substance use disorder. RECENT FINDINGS A growing body of literature suggests that affective symptoms and affective disorders may moderate substance use disorder treatment efficacy, mediate the effects of treatment on substance use outcomes, and may be directly changed by substance use disorder treatment. SUMMARY Substance use disorders and affective disorders commonly co-occur, and both affect and affective disorders are associated with substance use disorder treatment outcomes. Future research should continue to examine affect as a moderator, mediator, and outcome of substance use disorder treatments. In particular, new studies that are designed to test precision medicine hypotheses would greatly expand our understanding of the role of affective symptoms and disorders in substance use disorder treatment.
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Affiliation(s)
- Julia E Swan
- Department of Psychology, University of New Mexico
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Holzhauer CG, Wemm SE, Wulfert E, Cao ZT. Fluctuations in progesterone moderate the relationship between daily mood and alcohol use in young adult women. Addict Behav 2020; 101:106146. [PMID: 31639640 PMCID: PMC6876695 DOI: 10.1016/j.addbeh.2019.106146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Research has demonstrated associations between hormonal fluctuations during the menstrual cycle and women's alcohol use. This association has been explained by mood changes that, for some women, accompany decreasing levels of progesterone during the menstrual cycle, particularly during the late luteal/premenstrual phase. The current study examined whether participants' daily ratings of mood interact with changing levels of progesterone to predict alcohol use. METHOD Young adult women attended two sessions scheduled two weeks apart, during which they completed questionnaires and provided salivary samples for the assay of progesterone levels. In the intervening two weeks, participants completed daily logs of their mood, alcohol use, and menses. Ordered Generalized Linear Mixed Models assessed the effects of daily mood (examined as both a within- and between-subject variable) on the likelihood of drinking, as a function of menstrual cycle phase and changes in progesterone across the two weeks. RESULTS One standard deviation increase in progesterone corresponded to a 1.61 decrease in the odds of drinking. This main effect was moderated by daily mood. Women were more likely to drink during a decrease in progesterone on days they rated their mood as negative, whereas during an increase in progesterone they were more likely to drink on days they reported a positive mood. Between-subject analyses showed that women who reported lower overall mood during the two-week period were more likely to drink with an increase in progesterone and less likely with a decrease. CONCLUSIONS Women's likelihood to drink increased when they experienced negative mood in the context of decreasing levels of progesterone, whereas the negative-mood/drinking association was mitigated among those with increasing levels of progesterone. However, compared to women who on average had an overall more positive mood, women with an overall lower mood (and corresponding higher levels of depression and anxiety at baseline) did not experience the protective effects of rising progesterone levels on drinking.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- University of Massachusetts Medical School, Dept of Psychiatry, 365 Plantation Street, Worcester, MA 01605, United States.
| | - Stephanie E Wemm
- Yale University School of Medicine, Yale Stress Center, 2 Church Street South, Suite 209, New Haven, CT 06519, United States
| | - Edelgard Wulfert
- University at Albany, State University of New York, Psychology Department, 1400 Washington Avenue, Albany, NY 12222, United States
| | - Zhimin Tim Cao
- University at Albany, State University of New York, Psychology Department, 1400 Washington Avenue, Albany, NY 12222, United States; Wadsworth Center, New York State Department of Health, Albany, NY 12201, United States
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