Momentary Emotional Responding and Emotion Regulation in PTSD-Related Drinking Urge

The momentary processes that contribute to alcohol misuse among those with posttraumatic stress disorder (PTSD) are not well understood. Emotional responding (i.e., the intensity of an emotional response to a trauma-related stimulus) and emotion regulation (i.e., the ability to influence one's emotions), are two such crucial processes that may be important, in-the-moment determinants of drinking. This study investigated (a) associations among PTSD, emotional responding, and alcohol urge following exposure to a trauma cue, and (b) the conditional influence of emotion regulation abilities on these relationships. During an initial assessment session, 305 college students recruited from the community were classified based on Diagnostic and Statistical Manual of Mental Disorders Criterion A trauma exposure and PTSD symptom level: no trauma (NT), trauma exposure but no PTSD diagnosis (trauma only), or trauma exposure and PTSD (PTSD). During an experimental session, participants were presented with a personalized trauma cue. Emotional valence and arousal and urge to drink alcohol were reported before and after cue presentations. Emotional responding was indexed as postcue affective valence and arousal controlled for their respective baseline scores. Emotional responding to a trauma cue significantly mediated the relationship between any trauma exposure and urge to drink alcohol. Emotion regulation did not moderate this mediated pathway. Emotional responding increases momentary desires to use alcohol and may contribute to problematic drinking in those with trauma exposure. Findings may have important implications for intervention, as targeting emotional responding to trauma stimuli may help reduce alcohol risk. Future directions and limitations of the current work are discussed. Public Health Significance This study suggests that above and beyond individual tendencies to experience negative emotion, intense momentary negative emotional responses to reminders of trauma (i.e., emotional responding) are uniquely associated with immediate corresponding increases in one's urge to drink alcohol, regardless of that individual's abilities to regulate their emotions (i.e., emotion regulation). Importantly, this effect was not found exclusively among those with a diagnosis of posttraumatic stress disorder, but for anyone with a history of trauma. This work suggests that unique information for understanding the complex relationship between trauma and alcohol misuse can be fo