Targeting women veteran's stress-induced drinking with cognitive reappraisal: Mechanisms and moderators of change

Abstract

Emotion dysregulation mediates the effects of stress on drinking among individuals with co-occurring emotional and alcohol use disorders (AUD). The current study examined the effects of cognitive reappraisal (CR), an adaptive emotion regulation strategy, on mechanisms that contribute to drinking (alcohol craving, inhibitory control) among 50 women veterans. In session one, participants were randomized to one of two 50-min "microinterventions", either to learn a CR coping strategy or receive non-therapeutic psychoeducation control. In session two, all participants underwent a personalized stress induction, after which women in the experimental condition were instructed to use CR to reduce stress, while those in the control group were instructed to sit quietly. Craving and inhibitory control were measured at post-stress induction and after using CR/sitting quietly. Moderating effects of AUD, depression, and PTSD severity were assessed. Craving and inhibitory control improved among women in both conditions (CR or sitting quietly), with no main effect of condition. Condition by AUD severity had a significant interaction effect (b = 0.018, p = .013), whereby women with more severe AUD had greater decreases in craving after sitting quietly, and women with less severe AUD had greater decreases in craving after CR. The opposite pattern was observed for inhibitory control (b = 6.45, p = .004), with women with less severe AUD having greater decreases in inhibitory control after sitting quietly, and women with more severe AUD having greater decreases in inhibitory control after CR. Results highlight CR's immediate effects on alcohol-related outcomes and the important role of symptom severity.

Keywords: Alcohol; Cognitive reappraisal; Emotion regulation; Posttraumatic stress disorder; Stress; Veterans; Women.

Fig. 1.

CONSORT table.

Fig. 2.

Study procedures Note: Bolded items indicate measurement of outcome variables, including STOP-IT (behavioral measure of inhibitory control), and ACQ (self-report alcohol craving). PANAS, a self-report measure of negative affect, administered as well. See Methods for details. CR = Cognitive Reappraisal. Grey boxes = control group.

Fig. 3.

3-Way interaction effects on main study outcomes Note: Lower scores are “better” for both outcomes. AUD reflects high (mean + 1SD) and low (mean −1SD) scores on the full AUDIT. AUDIT scores were entered in analyses as a continuous variable and graphed here as dichotomous for visualization purposes only. For craving, the significant interaction was driven by differences at the post-stressor time point and differences within each group across time. Within the control group, the change from post-stressor to post-CR/SQ is significantly different based on severity of AUD. Within the cognitive reappraisal group, the change from post-stressor to post-CR/SQ is near-significant (p = .055) different based on severity of AUD. For SSRT, the significant interaction was driven by differences between groups at the post-CR/SQ time point.