What Is the Role of Affective Cognition in Trauma and Posttraumatic-Stress-Disorder-Related Drinking? A Systematic Review

Abstract

Trauma and posttraumatic stress disorder (TR/PTSD) are implicated in deleterious alcohol outcomes, yet the processes that undergird these associations remain elusive. Affective (i.e., emotionally laden) cognitions may play key roles in TR/PTSD-related drinking that could inform prevention and intervention. The present review synthesized extant literature (k = 58) on affective cognitions and their role in negative and positive reinforcement TR/PTSD-related drinking, including alcohol-specific (e.g., drinking motives, alcohol expectancies) and non-alcohol-specific (e.g., emotion regulation cognitions, perception and attentional biases) cognitions. Findings generally supported the importance of alcohol-specific cognitions in negative more so than positive reinforcement drinking. Non-alcohol-specific affective cognitions were considerably less researched. Several gaps in the knowledge base emerged; studies were overwhelmingly cross-sectional, conducted mainly within homogenous college samples, and often did not disaggregate effects of trauma exposure from those of PTSD. Future research is needed to address these gaps to optimally inform clinical efforts to reduce TR/PTSD-related drinking risk.

Keywords: affective cognition; alcohol consumption; coping drinking motives; posttraumatic stress disorder; trauma exposure.

Figure 1.

Flow Diagram of Studies Selected for Systematic Review. Diagram prepared in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021). TBI = traumatic brain injury; PTSD = posttraumatic stress disorder.

Figure 2.

Summary of Identified Research on Role of Affective Cognitions in Trauma/PTSD-related Alcohol Outcomes. Affective cognitions examined included alcohol cognitions, emotion regulation cognitions, and perception and attentional biases. Cognitions assessed across identified studies within these categories are summarized. Cognitive mediation depictions (i.e., diagonal lines) are weighted based on the number of studies reporting any significant mediational/indirect effects of the respective affective cognition in trauma- or PTSD-related alcohol outcomes. Cognitive moderation depictions (i.e., vertical lines) are weighted based on the number of studies reporting any significant interaction effects of the respective affective cognition with trauma- or PTSD-related alcohol outcomes.