Developmental differences in the impact of racial discrimination on depression and anxiety among Black youth: Examining rumination as a mechanism.

Experiences of racial discrimination are pervasive among Black youth, resulting in psychosocial problems such as depression and anxiety. Rumination plays a key role in linking racial discrimination and internalizing concerns. Developmental age has also been shown to influence the extent to which racial discrimination and rumination impact mental health; however, studies have yet to explore the interplay between these factors. This study examined the association between racial discrimination and internalizing concerns among Black youth, whether racial discrimination was indirectly associated with internalizing concerns through rumination, and whether developmental age moderated these direct and indirect effects. Participants included 158 pre- and early-adolescent youth recruited from a community sample (Mage = 11.56 years; 53% female). Data were from baseline questionnaire responses from a larger longitudinal study conducted in the Southeastern United States examining the effects of interpersonal stressors on youth mental health outcomes. Racial discrimination was directly and indirectly associated with internalizing concerns through rumination. Developmental age moderated the indirect link between racial discrimination and depressive symptoms via rumination with the association being stronger as participant age increased. The impact of racial discrimination on mental health among Black youth is informed by maladaptive coping strategies such as rumination and developmental age. Such factors help to identify who is most at risk for the impact of racial discrimination and potential intervening targets. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexual Risk Behavior among Adolescents Seeking Treatment for Posttraumatic Stress Disorder: Exploring Psychosocial & Symptom Correlates.

Adolescents exposed to trauma experience disproportionate rates of HIV/STI. However, integrated treatment for trauma and sexual risk behavior is rare. To inform integrated prevention efforts, the current study describes prevalence and correlates of sexual risk behavior among adolescents seeking treatment for symptoms of posttraumatic stress and substance use disorders. Adolescents aged 13-18 years (N = 135; 88% female) with histories of interpersonal violence exposure completed pre-treatment questionnaires in a randomized controlled trial of an integrated psychotherapy for trauma and substance use symptomology. Adolescents reported high rates of sexual risk behaviors relative to national estimates and general mental health treatment samples. Symptoms of reexperiencing, substance use, and peer deviance were related to sexual risk behavior beyond the influence of other trauma symptoms. Individual and contextual psychosocial factors may be stronger predictors of sexual risk behavior than posttraumatic stress disorder symptoms among adolescents with trauma symptomology. Integrated interventions targeting traumatic stress, substance use, and sexual risk behavior concurrently may prevent revictimization and HIV/STI incidence among trauma-exposed youth.

History of rape moderates the pathways from emotion dysregulation to alcohol and risky sex outcomes among college women.

OBJECTIVE: Affective and emotional dysregulation are consistently linked to greater alcohol use and related consequences, including risky sexual behavior. Moreover, these associations are even stronger among women with experiences of sexual assault. The current study tested affect, alexithymia, positive urgency, and negative urgency as predictors of alcohol use, alcohol-related consequences, and risky sexual behavior and the moderating impact of rape history on these associations among a sample of college women. METHOD: Participants were 1,005 college women between the ages of 18 and 25. Approximately 20% of the sample (n = 204) reported a history of rape since age 14. RESULTS: Positive and negative urgency statistically mediated the associations between negative affect and alexithymia and the alcohol and risky sex outcomes. Positive urgency was directly associated with alcohol use, while negative urgency was directly associated with alcohol-related consequences. Moreover, rape history moderated these associations, indicating that positive affect may be an important protective factor among women who have experienced rape. CONCLUSIONS: The current study identified important unique risk and protective pathways that may increase or reduce women's risk for alcohol-related consequences and risky sexual behavior. Importantly, these pathways are comprised of constructs that are malleable and modifiable and can be targeted and changed through intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations of subjective and objective stress responses with interpersonal trauma, PTSD, stress-induced drinking, and drinking to cope in young adults.

OBJECTIVE: To understand how interpersonal trauma (IPT), stress response, and drinking to cope converge to predict stress-induced drinking, a risk factor for alcohol use disorder. METHOD: Young adults with no substance use disorder were classified into three trauma history groups: (a) IPT with PTSD (n = 27), (b) IPT without PTSD (n = 35), and (c) Control (no trauma-history/no PTSD; n = 36). Participants completed a baseline assessment, including a structured clinical interview, to confirm PTSD diagnosis, followed by the Trier Social Stressor Task (TSST) and an alcohol use task. Subjective units of distress and blood serum cortisol were collected at standardized timepoints throughout the tasks. RESULTS: In all three groups (PTSD, IPT, control), males consumed more alcohol in the lab than females. Participants in the PTSD group had significantly higher drinking to cope motives, which were associated with greater subjective reactivity; however, neither drinking to cope motives nor subjective reactivity to the TSST predicted post-stressor alcohol consumption for those with PTSD. CONCLUSIONS: The interplay among trauma history, stress, and drinking among young adults is nuanced; additional lab-based studies are needed to further clarify the nuanced connection between trauma history, acute stress reactions, and alcohol use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Women's Perceived Likelihood to Engage in Sexual Risk Taking: Posttraumatic Stress Symptoms and Poor Behavioral Regulation.

Sexual abuse prior to age 18 may put some women at risk for engaging in sexual risk taking. This association could exist, in part, as a result of the impact of posttraumatic stress symptoms on behavioral regulation. The current study utilized a path analysis to investigate the association between severity of sexual abuse before age 18, posttraumatic stress symptoms, poor behavioral regulation, and expected engagement in sexual risk taking among college women. The sample consisted of 88 college women with experiences of sexual abuse prior to the age of 18. Severity of sexual abuse predicted posttraumatic stress symptoms. In addition, posttraumatic stress symptoms predicted poor behavioral regulation, which in turn predicted expected engagement in sexual risk taking. These findings indicate functional mechanisms involved in sexual decision making of women who have had past sexual abuse and experience posttraumatic stress symptoms.

Drunkorexia: Normative behavior or gateway to alcohol and eating pathology?

Drunkorexia is characterized by a group of behaviors designed to minimize caloric intake while maximizing levels of alcohol intoxication. Individuals plan and modify their diet, via skipping meals, exercising, or purging, to save calories for a night of alcohol consumption. Minimal research has examined risk factors related to drunkorexia, and little is known regarding associated problems. We used structural equation modeling to test associations between coping and enhancement motives, drive for thinness, body dissatisfaction, and disordered eating (i.e., bulimia behaviors) and drinking among an at-risk college population (N = 364). Drive for thinness and alcohol coping motives were positively associated with drunkorexia. Notably, drunkorexia was associated with alcohol-related outcomes, but not bulimia. While common risk factors are shared with eating pathology, drunkorexia appears to be a unique construct apart from bulimia behaviors. Results indicate drunkorexia behaviors may extend past normative drinking and place individuals at increased risk of alcohol-related problems. The current study contributes to greater understanding of functional models and maladaptive outcomes related to drunkorexia behaviors.

Predictors of substance use in a clinical sample of youth seeking treatment for Trauma-related mental health problems.

Child maltreatment and traumatic events are well established risk factors for adolescent substance use problems, but little is known about the unique contributions of etiological factors on trauma-exposed youths' pre-treatment substance use in clinical settings. This study examined associations between substance use and risk and protective factors measured across multiple ecological levels among a unique sample of youth seeking treatment for trauma-related mental health problems in child advocacy centers. Participants were adolescents (N = 135; 85% female; 60% white, 31% black) aged 13-17 years (M = 15.4) with ≥ 1 experience of child maltreatment or other interpersonal violence, current substance use, and ≥5 PTSD symptoms. Youth and caregivers completed validated questionnaires and clinical interviews at a pre-treatment assessment in a randomized controlled trial of a treatment for co-occurring traumatic stress and substance use. Negative binomial regression models identified different patterns of risk and protective factors for alcohol and cannabis. Clinical implications of these results are discussed, including the potential targets for integrated psychotherapies that address co-occurring substance use and traumatic stress in youth.

Risk reduction through family therapy (RRFT): Protocol of a randomized controlled efficacy trial of an integrative treatment for co-occurring substance use problems and posttraumatic stress disorder symptoms in adolescents who have experienced interpersonal violence and other traumatic events.

Decades of research demonstrate that childhood exposure to traumatic events, particularly interpersonal violence experiences (IPV; sexual abuse, physical abuse, witnessing violence), increases risk for negative behavioral and emotional outcomes, including substance use problems (SUP) and posttraumatic stress disorder (PTSD). Despite this well-established link-including empirical support for shared etiological and functional connections between SUP and PTSD -the field has been void of a gold standard treatment for adolescent populations. To address this gap, our team recently completed a large randomized controlled trial to evaluate the efficacy of Risk Reduction through Family Therapy (RRFT), an integrative and exposure-based risk-reduction and treatment approach for adolescents who have experienced IPV and other traumatic events. The purpose of this paper is to provide a detailed description of the design and methods of this RCT designed to reduce SUP, PTSD symptoms, and related risk behaviors, with outcomes measured from pre-treatment through 18 months post-entry. Specifically, the recruitment and sampling procedures, assessment measures and methods, description of the intervention, and planned statistical approaches to evaluating the full range of outcomes are detailed. Clinical and research implications of this work are also discussed.

A model of reinforcement sensitivity, impulsivity, alcohol use, and risky sexual behavior in a sample of young adult drinkers.

This study tested a structural equation model linking reinforcement sensitivity to subsequent emotion-based impulsivity (i.e., positive and negative urgency), alcohol use, and risky sexual behavior among a sample of 753 undergraduate drinkers. A hypothesized Sensitivity to Punishment (SP) × Sensitivity to Reward (SR) interaction significantly predicted both positive and negative urgency. At low levels of SR, SP had a significant negative effect on positive urgency and a significant positive effect on negative urgency. However, at high levels of SR, SP had significant positive effects on both types of urgency. Results indicated that positive and negative urgency mediate the associations between reinforcement sensitivity and both alcohol use and risky sexual behavior. Moreover, results demonstrated that at low levels of SR, SP is indirectly associated with decreased alcohol use. However, as SR increases, SP is indirectly associated with increased alcohol use and risky sexual behavior, due to the joint effect of high SP and SR on emotion-based impulsivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prediction of verbal and physical aggression among young adults: A path analysis of alexithymia, impulsivity, and aggression.

Alexithymia is a personality construct characterized by difficulties in identifying and describing emotions. Previous research has identified a positive association between alexithymia and aggression, and impulsivity may account for some of that association. This study tested a path model of associations between alexithymia, five facets of impulsivity (negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking), and verbal and physical aggression in a sample of 503 undergraduate students. Alexithymia had significant positive associations with all facets of impulsivity except for sensation seeking. Negative urgency and (lack of) premeditation mediated the relationship between alexithymia and verbal aggression. Positive urgency, negative urgency, and (lack of) premeditation mediated the relationship between alexithymia and physical aggression. Positive urgency also moderated the relationship between alexithymia and both forms of aggression, increasing the strength of those associations. These results highlight the role of emotion dysregulation in the context of aggression and support the use emotion regulation skills training in anger and aggression management programs.

Can cognitive bias modification simultaneously target two behaviors? Approach bias retraining for alcohol and condom use.

This study tested the effectiveness of a cognitive bias modification (CBM) intervention to simultaneously reduce approach biases toward alcohol and increase approach biases toward condoms among high-risk young adults. Participants (N = 102) were randomly assigned to either a training condition or a sham-training condition. Participants in the training condition were trained to make avoidance movements away from alcohol stimuli and approach movements toward condom stimuli over four training sessions. Approach biases and behavior were assessed at pretest, posttest, and 3-month follow-up. Approach biases changed for both stimulus categories in accordance with training condition. Condom behavior and attitudes also changed as a function of training condition, such that participants in the training condition reported fewer instances of condom nonuse and a more positive attitudes toward condoms at a three-month follow-up. Participants in both conditions had significant reductions in alcohol consumption following the intervention and did not differ by training condition.

Daily associations between alcohol and sexual behavior in young adults.

We tested within-person effects of alcohol on sexual behavior among young adults in a longitudinal burst design (N = 213, 6,487 days) using data collected from a previously published parent study. We differentiated effects of alcohol on likelihood of sexual activity versus use of protection against sexually transmitted diseases (STDs) or pregnancy on intercourse occasions by testing a multilevel multinomial model with 4 outcomes (no sex, oral sex without intercourse, protected intercourse, and unprotected intercourse). At the within-person level, effects of alcohol were hypothesized to be conditional upon level of intoxication (i.e., curvilinear effect). We also tested effects of four between-person moderators: gender, typical length of relationship with sexual partners, and two facets of self-control (effortful control and reactivity). Consistent with our hypothesis, low-level intoxication was associated with increased likelihood of engaging in oral sex or protected intercourse (relative to no sex) but was not related to likelihood of unprotected intercourse. The effect of intoxication on unprotected versus protected intercourse was an accelerating curve, significantly increasing likelihood of unprotected intercourse at high levels of intoxication. Between-person factors moderated associations between intoxication and sexual behavior. Effects of intoxication on both protected and unprotected intercourse were diminished for individuals with more familiar sexual partners. Effortful control exhibited a protective effect, reducing the effects of intoxication on likelihood of unprotected intercourse. Hypothesized effects of reactivity were not supported. Intoxication was a stronger predictor of oral sex and protected intercourse (but not unprotected intercourse) for women relative to men. Results highlight the inherent complexities of the alcohol-sexual behavior nexus. (PsycINFO Database Record

Emotion dysregulation and peer drinking norms uniquely predict alcohol-related problems via motives.

This study examined the relationships between emotion dysregulation, peer drinking norms, drinking motives, and alcohol-related outcomes among 435 college students. We examined the mediating roles of drinking motives when predicting alcohol consumption and related problems from the subscales of the Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer, 2004) via negative and positive reinforcement models. First, we hypothesized that individuals who lack in emotion regulation strategies or have difficulties in accepting negative emotions are more likely to drink to cope. Additionally, we hypothesized that individuals who act impulsively or become distracted when upset as well as those with higher peer drinking norms are more likely to drink for social and enhancement motives. The results of the path model indicated that limited access to emotion regulation strategies significantly predicted alcohol-related problems via both depression and anxiety coping motives, but did not predict alcohol consumption. Nonacceptance of emotional responses was not significantly associated with coping motives. Impulsivity had a significant direct relationship with alcohol problems. Difficulty in engaging in goal-directed behaviors predicted both enhancement and social motives, but only enhancement motives in turn predicted consumption. Norms indirectly predicted problems via enhancement motives and consumption. The results indicated that using alcohol to reduce negative or to increase positive emotions increases alcohol consumption and alcohol-related problems. Overall, results advance our understanding of the mechanisms of increased alcohol use and problems among college students.

Childhood Maltreatment and Sexual Risk Taking: The Mediating Role of Alexithymia.

Childhood maltreatment is a significant predictor of sexual risk taking. The nature of this relationship is not fully understood; however, emotion dysregulation may play an important role. We tested the role of difficulty identifying and describing feelings (i.e., alexithymia) on the relationship between childhood maltreatment and sexual risk taking. Specifically, we hypothesized two mechanisms, one in which alexithymia is related to sexual risk taking via negative urgency and alcohol use and a second one in which alexithymia is related to sexual risk taking via neediness. The participants for this study were 425 sexually active college undergraduates (303 females, 122 males) between the ages of 18 and 25 years. The results of a structural equation model indicated that alexithymia accounted for a significant part of the relationship between child maltreatment and sexual risk behavior. Moreover, the relationship between alexithymia and sexual risk taking was fully accounted for by two separate paths. First, negative urgency and subsequent alcohol use partially mediated the relationship, and the second effect was accounted for by needy interpersonal style. Adverse experiences during childhood can impair emotional functioning and contribute to behavioral and interpersonal dysregulation.

Alexithymia, Coping Styles and Traumatic Stress Symptoms in a Sample of Veterans Who Experienced Military Sexual Trauma.

The current study examined the association between alexithymia and coping styles (planning, positive reinterpretation and growth, social-emotion coping, and denial), and trauma symptoms in a clinical sample of 170 male and female veterans who experienced sexual trauma during military service. Denial was the only coping style positively associated with trauma symptoms, and it mediated the relationship between alexithymia and trauma symptoms. Alexithymia was negatively associated with planning. Likewise, alexithymia was negatively associated with social-emotional coping and with positive reinterpretation and growth. The results speak to the significant role that alexithymia has in predicting individual coping styles.

Five Factors of Impulsivity: Unique Pathways to Borderline and Antisocial Personality Features and Subsequent Alcohol Problems.

Impulsivity, a multidimensional behavioral mechanism, commonly preceding externalizing maladaptive behavior and psychopathology, is a diagnostic criterion central to both antisocial and borderline personality disorders (American Psychiatric Association; APA, 2013). This study tested a path model of associations between five facets of impulsivity (negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking), borderline personality features, antisocial personality features, and two alcohol outcomes (consumption and alcohol-related problems) in a sample of college students (N = 624; 69% female, 31% male) between the ages of 18-25 (M = 19.77, SD = 1.55). The model demonstrated good fit with X 2 (14, N = 624) = 17.48, p = .231; RMSEA = .020 [90% CI: .000 - .046]; CFI = .998; SRMR = .019. Negative urgency and (lack of) perseverance predicted borderline personality features. Positive urgency, sensation seeking, (lack of) premeditation, and negative urgency predicted antisocial personality features. Antisocial, but not borderline personality features, were significantly associated with alcohol consumption. However, both antisocial and borderline personality features significantly predicted alcohol problems. Overall, the results demonstrate that impulsivity facets can differentially predict personality psychopathology and illustrate distinct paths to alcohol consumption and problems.

Military sexual trauma, combat exposure, and negative urgency as independent predictors of PTSD and subsequent alcohol problems among OEF/OIF veterans.

This study tested a path model of relationships between military sexual trauma (MST), combat exposure, negative urgency, posttraumatic stress disorder (PTSD) symptoms, and alcohol use and related problems. The sample consisted of 86 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans who reported drinking at least one alcoholic beverage per week. PTSD mediated the relationships between MST and alcohol-related problems, negative urgency and alcohol-related problems, and combat exposure and alcohol-related problems. In addition, negative urgency had a direct effect on alcohol problems. These results indicate that MST, combat exposure, and negative urgency independently predict PTSD symptoms and PTSD symptoms mediate their relationship with alcohol-related problems. Findings support previous literature on the effect of combat exposure and negative urgency on PTSD and subsequent alcohol-related problems. The current study also contributes to the limited research regarding the relationship between MST, PSTD, and alcohol use and related problems. Clinical interventions aimed at reducing emotional dysregulation and posttraumatic stress symptomology may subsequently improve alcohol-related outcomes.

Control and Alcohol-Problem Recognition Among College Students.

OBJECTIVE: This study examined negative control (ie, perceived lack of control over life outcomes) and need for control as predictors of alcohol-problem recognition, evaluations (good/bad), and expectancies (likely/unlikely) among college students. The study also explored the interaction between the need for control and alcohol consumption in alcohol-related outcomes. PARTICIPANTS: Participants were a convenience sample of 500 college students from a rural Midwest university. Data were collected during the 2009-2010 academic year. METHODS: Participants completed a survey assessing control and alcohol-problem recognition, evaluations, and expectancies. RESULTS: Negative control demonstrated a significant positive association with alcohol-problem recognition, evaluations, and expectancies after controlling for gender and alcohol consumption. Need for control did not have a main effect. However, the interaction was significant in that the association between need for control and negative evaluation of alcohol problems was strongest among participants with the highest levels of alcohol consumption. CONCLUSIONS: These results demonstrate that individuals' differences in sense of control are associated with alcohol-problem recognition, evaluations, and expectancies in young adults.

Associations between sensitivity to punishment, sensitivity to reward, and gambling.

The majority of individuals gamble during their lifetime; however only a subset of these individuals develops problematic gambling. Gray's Reinforcement Sensitivity Theory may be relevant to understanding gambling problems. Differences in sensitivity to punishments and rewards can influence an individual's behavior and may be pertinent to the development of gambling problems. This study examined the functional associations between sensitivity to punishment (SP), sensitivity to reward (SR), and gambling problems in a sample of 2254 college students. Zero-inflated negative binomial regression was used to predict gambling problems as well as the absence of gambling problems. Gambling problems were hypothesized to be positively associated with SR and inversely associated with SP. In addition, SP was hypothesized to moderate the association between SR and gambling problems, attenuating the strength of the association. As hypothesized, SR was positively associated with gambling problems. However, SP did not moderate the relationship between SR and gambling problems. SP did, however, moderate the relationship between SR and the likelihood of never experiencing gambling problems. The results demonstrate that individual differences in SP and SR are functionally associated with gambling problems.

An experience sampling study of PTSD and alcohol-related problems.

Posttraumatic stress disorder (PTSD) represents a debilitating psychiatric condition that is affecting the lives of many returning veterans. PTSD and alcohol use and dependence are highly comorbid. The purpose of this study was to understand the functional mechanisms between PTSD and alcohol use and problems. Specifically, the role of negative urgency and emotional intelligence were investigated as vulnerability and resiliency factors, respectively. This study utilized experience sampling to test associations between PTSD symptoms and alcohol use and related problems in a sample of 90 OIF/OEF veterans. Participants completed 8 brief questionnaires daily for 2 weeks on palmtop computers. Elevations in PTSD symptoms during the day were associated with subsequent increases in alcohol use and associated problems that night. PTSD symptoms were associated with greater problems above and beyond the effect of drinking level at both the within- and between- person level. Emotional intelligence was associated with lower negative urgency, fewer PTSD symptoms, and less alcohol use and associated problems. The effects of emotional intelligence were primarily indirect via negative urgency and the effects of negative urgency on alcohol use and problems were indirect via its positive association with PTSD symptoms. Hypothesized cross-level effects of emotional intelligence and negative urgency were not supported. The findings suggest a functional association between PTSD symptoms and alcohol consumption. The association between PTSD symptoms and alcohol consumption is consistent with a self-medication model. However, the significant associations between PTSD symptoms and alcohol problems, after controlling for use level, suggest a broader role of dysregulation.