Daily exposure to combat-related cues and posttraumatic stress symptoms among veterans: Moderating effects of peri- and postdeployment experiences.

One of the central symptoms of posttraumatic stress disorder (PTSD) is a heightened reactivity to trauma cues. The current study used experience sampling to investigate the associations between exposure to combat-related cues and PTSD symptoms in 93 U.S. veterans who served in support of recent military operations in Afghanistan and Iraq. We also examined the effects of peri- and postdeployment factors, including exposure to combat, unit support during deployment, and postdeployment social support on PTSD. Participants completed eight brief random surveys daily for 2 weeks using palmtop computers. The results indicated that more daytime exposure to trauma cues was associated with experiencing more PTSD symptoms at the within-person level, B = 3.18. At the between-person level, combat exposure, B = 4.20, was associated with more PTSD symptoms, whereas unit support, B = -0.89, was associated with experiencing fewer symptoms. At the cross-level interaction, unit support, B = -0.80, moderated the association between trauma cue exposure and PTSD symptom count. Contrary to our hypothesis, postdeployment social support, B = -0.59, was not associated with PTSD symptoms. These findings suggest a functional association between exposure to trauma cues and PTSD symptoms among recent-era U.S. veterans and underscore the importance of unit support during deployment.

Anhedonia and impulsivity in college alcohol use: A path analysis.

OBJECTIVE: Alcohol use is a substantial problem among college students and has several negative consequences. The current study examined the associations between anhedonia and alcohol use and related problems via impulsive behavior (e.g., negative urgency, sensation seeking). We parsed anhedonia into four specific facets: consummatory, anticipatory, recreational, and social anhedonia. PARTICIPANTS: Six hundred and forty college students aged 18-25 were included in the final analysis. METHOD: Data were collected via Amazon Mechanical Turk. Self-report inventories assessing for anhedonia, alcohol use, impulsive behavior, and depressed mood were utilized. RESULTS: Recreational consummatory anhedonia was negatively associated with alcohol use and alcohol-related problems through negative urgency. Recreational consummatory anhedonia also had significant negative associations with alcohol consumption via sensation seeking. Further, social anticipatory anhedonia was positively associated with alcohol use and related problems via negative urgency. CONCLUSIONS: This study highlights important associations between anhedonia, impulsivity, and alcohol use and related problems.

Risk factors for traumatic bonding and associations with PTSD symptoms: A moderated mediation.

BACKGROUND: Traumatic bonding, defined as attachment to a perpetrator of intimate partner violence (IPV), offers one explanation as to why many people with abusive romantic partners do not break off these relationships. But what individual-level risk factors make some victims of IPV more likely than others to develop traumatic bonding toward their partners? What is the nature of the potential association between traumatic bonding and PTSD symptoms? PARTICIPANTS: A path model tested the potential roles of childhood maltreatment and attachment insecurity as risk factors for traumatic bonding, as well as the potential association between traumatic bonding and PTSD symptoms, in a high-risk sample of 354 participants in current abusive relationships. RESULTS: As hypothesized, childhood maltreatment and attachment insecurity significantly predicted traumatic bonding over and above the effects of age, gender, and romantic love. In addition, attachment insecurity moderated the association between childhood maltreatment and traumatic bonding, such that at higher levels of attachment insecurity, the association between childhood maltreatment and traumatic bonding was stronger than at mean or lower levels of attachment insecurity. Traumatic bonding was positively associated with PTSD symptoms. CONCLUSIONS: Overall, the results support the role of childhood maltreatment as a risk factor for both traumatic bonding and PTSD symptoms and highlight the importance of attachment insecurity in these associations. This was the first study to examine a complex model of risk factors for traumatic bonding. Theoretical and clinical implications are discussed.

Understanding Pedophilia: A Theoretical Framework on the Development of Sexual Penchants.

Pedophilia is a significant public health problem. Despite its cost to society, little effort has been directed toward understanding idiographic differences in the development and maintenance of pedophilia. Extant literature emphasizes biological underpinnings and predictors of re-offense. In this article, we posit that pedophilic penchants in males originate due to language, cognition, emotions, and emotion regulation. Adverse childhood experiences, such as emotional and sexual abuse, are posited as a major contributor to the etiology of pedophilia. However, not all individuals attracted to minors present with similar childhood adversities. The development of pedophilia, in the absence of such direct training (childhood adversities), is difficult to comprehend. Relational frame theory, a comprehensive account of human language and cognition, aids in deciphering the idiographic underpinnings of pedophilia. The role of maladaptive emotion regulation in maintaining pedophilia is also described. This article presents examples of how relational frames are established and activated in distressing contexts. Finally, implications for future research are discussed.

Network analysis of distress, suicidality, and resilience in a treatment seeking sample of first responders.

INTRODUCTION: First responders are routinely and regularly exposed to traumatic events that can clinically manifest with a symptom constellation of posttraumatic stress disorder (PTSD), generalized anxiety, depression, and suicidality. METHODS: We used network analysis to examine baseline data from treatment seeking first responders (n = 308) to examine the interrelatedness of those constructs, including a measure of resilience. We estimated two models: a regularized partial correlation network and a Bayesian Directed Acyclic Graph (DAG). RESULTS: The models reveal converging evidence highlighting the central role of negative alterations in cognitions and mood PTSD cluster along with affective depression. These nodes did not significantly differ, though they were among the strongest in the partial correlation network and shared the most variance with the other nodes. The DAG results suggested that the negative alterations in cognitions and mood PTSD cluster predicted downstream constructs of affective depression; intrusion, hyperarousal, and avoidance PTSD clusters; and resilience. Only resilience and affective depression exhibited direct effects on suicidality. Both somatic depression and suicidality were endogenous endpoints in the DAG. Resilience exhibited an inverse path to suicide. However, resilience was relatively independent of the other constructs in the models and the DAG suggested that it was a consequence of PTSD related distress. LIMITATIONS: The data is cross-sectional in nature that should be followed up in longitudinal studies. CONCLUSION: Findings are discussed in respect to the role of distress and emotional dysregulation as common factors underlying a broad range of internalizing problems.

Associations of experiential avoidance with burnout, wellbeing, and productivity loss among police officers: The mediating role of negative and positive affect.

OBJECTIVES: The current study aims to investigate the indirect associations between experiential avoidance (EA) and burnout, wellbeing, and productivity loss (PL) via the mediating role of positive and negative emotions among police officers. METHODS: Data were collected on 187 officers (84% male) aged 21-64 years between 2019 and 2020. Participants completed online self-report measures. RESULTS: EA was indirectly associated with burnout via positive and negative affect. EA was indirectly associated with wellbeing through positive affect, positive affect and burnout, and negative affect and burnout. Finally, EA was indirectly associated with PL via positive affect and burnout, and negative affect and burnout. CONCLUSION: Results provide support for the role of EA in officers' wellbeing and job performance via increasing negative affect and decreasing positive affect. This highlights the importance of interventions, such as acceptance and commitment therapy that target acceptance and psychological flexibility.

Remodeling of the Cortical Structural Connectome in Posttraumatic Stress Disorder: Results From the ENIGMA-PGC Posttraumatic Stress Disorder Consortium.

BACKGROUND: Posttraumatic stress disorder (PTSD) is accompanied by disrupted cortical neuroanatomy. We investigated alteration in covariance of structural networks associated with PTSD in regions that demonstrate the case-control differences in cortical thickness (CT) and surface area (SA). METHODS: Neuroimaging and clinical data were aggregated from 29 research sites in >1300 PTSD cases and >2000 trauma-exposed control subjects (ages 6.2-85.2 years) by the ENIGMA-PGC (Enhancing Neuro Imaging Genetics through Meta Analysis-Psychiatric Genomics Consortium) PTSD working group. Cortical regions in the network were rank ordered by the effect size of PTSD-related cortical differences in CT and SA. The top-n (n = 2-148) regions with the largest effect size for PTSD > non-PTSD formed hypertrophic networks, the largest effect size for PTSD < non-PTSD formed atrophic networks, and the smallest effect size of between-group differences formed stable networks. The mean structural covariance (SC) of a given n-region network was the average of all positive pairwise correlations and was compared with the mean SC of 5000 randomly generated n-region networks. RESULTS: Patients with PTSD, relative to non-PTSD control subjects, exhibited lower mean SC in CT-based and SA-based atrophic networks. Comorbid depression, sex, and age modulated covariance differences of PTSD-related structural networks. CONCLUSIONS: Covariance of structural networks based on CT and cortical SA are affected by PTSD and further modulated by comorbid depression, sex, and age. The SC networks that are perturbed in PTSD comport with converging evidence from resting-state functional connectivity networks and networks affected by inflammatory processes and stress hormones in PTSD.

Reinforcement sensitivity and bulimia symptoms: the role of emotion regulation.

OBJECTIVE: Reinforcement Sensitivity Theory (RST) provides a theoretical foundation associated with various approach and avoidance behaviors and individual personality differences. Sensitivity to reward and punishment, two neural systems within the RST have been significantly associated with bingeing and purging behaviors. However, inconsistent findings are observed and specific factors mediating these relationships are not well understood. Deficits in emotion regulation may account for these relationships, as both negative urgency and distress tolerance have been independently associated with bulimia behaviors. Thus, this is an area that requires further investigation. METHOD: The current study utilized various self-report inventories, including the Eating Disorder Inventory-3rd Edition to measure bulimia symptoms, as well as measures of negative affect, sensitivity to reward and punishment, distress tolerance, and negative urgency. These measures were used to assess whether distress tolerance and negative urgency mediated associations between sensitivity to reward and punishment and bulimia symptoms in a community sample of 394 young adults ranging from the ages of 18 to 25. RESULTS: As expected, sensitivity to reward and punishment were significantly associated with decreased distress tolerance. Distress tolerance was also directly associated with greater negative urgency, which was significantly associated with increased bulimia symptoms. Consistent with hypotheses, indirect associations between sensitivity to reward and sensitivity to punishment to bulimia symptoms via distress tolerance and negative urgency were observed, controlling for gender and negative affect. DISCUSSION: Results contribute to understanding specific contributions of risk factors within the relationship of sensitivity to reward and punishment and bulimia symptoms, measured by the EDI-3. Novel to existing literature, results indicate that reinforcement sensitivity significantly contributes to emotion regulation deficits. Thus, these findings may have important implications for understanding the development and treatment of bulimia symptoms. LEVEL OF EVIDENCE: Level V, based on descriptive, cross-sectional data.

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).

Assessment of brain age in posttraumatic stress disorder: Findings from the ENIGMA PTSD and brain age working groups.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with markers of accelerated aging. Estimates of brain age, compared to chronological age, may clarify the effects of PTSD on the brain and may inform treatment approaches targeting the neurobiology of aging in the context of PTSD. METHOD: Adult subjects (N = 2229; 56.2% male) aged 18-69 years (mean = 35.6, SD = 11.0) from 21 ENIGMA-PGC PTSD sites underwent T1-weighted brain structural magnetic resonance imaging, and PTSD assessment (PTSD+, n = 884). Previously trained voxel-wise (brainageR) and region-of-interest (BARACUS and PHOTON) machine learning pipelines were compared in a subset of control subjects (n = 386). Linear mixed effects models were conducted in the full sample (those with and without PTSD) to examine the effect of PTSD on brain predicted age difference (brain PAD; brain age - chronological age) controlling for chronological age, sex, and scan site. RESULTS: BrainageR most accurately predicted brain age in a subset (n = 386) of controls (brainageR: ICC = 0.71, R = 0.72, MAE = 5.68; PHOTON: ICC = 0.61, R = 0.62, MAE = 6.37; BARACUS: ICC = 0.47, R = 0.64, MAE = 8.80). Using brainageR, a three-way interaction revealed that young males with PTSD exhibited higher brain PAD relative to male controls in young and old age groups; old males with PTSD exhibited lower brain PAD compared to male controls of all ages. DISCUSSION: Differential impact of PTSD on brain PAD in younger versus older males may indicate a critical window when PTSD impacts brain aging, followed by age-related brain changes that are consonant with individuals without PTSD. Future longitudinal research is warranted to understand how PTSD impacts brain aging across the lifespan.

The indirect effect from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal.

BACKGROUND: Emotion regulation strategies may help explain the risk of experiencing posttraumatic stress disorder (PTSD) symptoms among adults with a history of child maltreatment. However, no study to date has examined the roles of both thought suppression and cognitive reappraisal in the association between childhood maltreatment and PTSD symptoms. OBJECTIVE: The current study sought to understand the associations between childhood maltreatment, thought suppression, cognitive reappraisal, and PTSD symptoms while controlling for negative affect and gender. PARTICIPANTS AND SETTING: Data were collected on 660 university students (71 % female) ages 18-25 between 2013 and 2014. Participants completed self-report measures of childhood maltreatment, PTSD symptoms, and emotion regulation strategies. METHOD: A structural equation model was tested to examine the direct and indirect effects from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal, over and above gender and negative affect. RESULTS: Childhood maltreatment was directly associated with PTSD symptoms (ß = 0.28, SE = 0.04, p < .001). Childhood maltreatment also had a significant indirect effect on PTSD via cognitive reappraisal (ß = 0.01, CI 95 % [0.00, 0.03]), but not through thought suppression, although (ß = 0.01, CI 95 % [-0.00, 0.04]) thought suppression was significantly positively associated with PTSD symptoms (ß = 0.21, SE = 0.04, p < .001). CONCLUSION: The present study sheds light on the effect of childhood maltreatment and two commonly used emotion regulation strategies on PTSD symptoms.

Distinct paths to alcohol problems: Impacts of childhood maltreatment, attachment insecurity, and interpersonal problems.

Childhood maltreatment is a strong risk factor for increased alcohol use and alcohol-related problems. One possible explanation for these associations is the influence of dysfunctional attachment styles and interpersonal problems in adulthood. Individuals who have experienced childhood maltreatment are likely to develop maladaptive interpersonal styles due to insecure attachment. Maladaptive interpersonal styles may increase emotional distress, which in turn, can make these individuals vulnerable to alcohol use and alcohol-related problems. Using data from 508 undergraduate students, this study examined the associations between three types of childhood maltreatment (i.e., sexual abuse, punishment that included physical abuse, and a negative home atmosphere that included neglect), alcohol use, and alcohol-related problems via insecure attachment and interpersonal problems. The results showed that punishment predicted alcohol problems via avoidant attachment and selfish interpersonal style. Sexual abuse and negative home atmosphere predicted alcohol consumption through anxious attachment and selfless interpersonal style. In addition, sexual abuse directly predicted alcohol problems. These findings provide new insights for the field of childhood maltreatment and addiction literature.

Affective dynamics among veterans: Associations with distress tolerance and posttraumatic stress symptoms.

We tested a dynamic structural equation model (DSEM; Asparouhov, Hamaker, & Muthén, 2018) of positive and negative affect in 254 veterans with approximately 1.5 years of experience sampling data. The analysis provided estimates of several aspects of veteran's emotional experience including "trait" positive and negative affect (i.e., mean levels), inertia (i.e., tendency for emotions to self-perpetuate), innovation variance (conceptualized as lability, reactivity, or exposure to stressors), and cross-lagged associations between positive and negative affect. Veterans with higher trait negative affect had more negative affect inertia and innovation variance. This suggests a pattern whereby the veteran has more negative reactions, and negative emotions, in turn, tend to maintain themselves, contributing to higher trait negative affect. In contrast, veterans with higher trait positive affect exhibited more positive affect innovation variance (e.g., positive reactivity). Although veterans showed some consistency in dynamics across emotions (e.g., positive and negative reactivity were positively correlated), trait positive and negative affect were not significantly associated. Veterans with higher posttraumatic stress symptoms (PTSS) at baseline exhibited higher reactivity to negative events, less positive affect, and more negative affect during the follow-up. Veterans with higher distress tolerance reported not only lower PTSS but also a more adaptive pattern of affective experience characterized by lower inertia and reactivity in negative affect and more positive lagged associations between negative affect and subsequent positive affect. The results demonstrated that distress tolerance and PTSS in veterans were associated with dynamics of positive and negative emotion over time, suggesting specific differences in affect regulation processes. (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.

Posttraumatic Stress Disorder and Conduct Problems: The Role of Self-Control Demands.

We tested within- and between-person effects of posttraumatic stress disorder (PTSD) symptoms on conduct problems and alcohol intoxication via self-control demands using multilevel structural equation modeling in a longitudinal burst-design study of 251 U.S. veterans who participated in the recent wars in Iraq and Afghanistan. We theorized that experiencing PTSD symptoms engenders efforts to regulate mood, control thoughts, and inhibit or control behavior that is taxing to the individual (i.e., it places demands on self-control) and hypothesized that this process results in subsequent deficits in regulatory control that manifest in heightened intoxication and conduct problems associated with PTSD. At the within-person level, daytime PTSD symptoms, IRR = 1.09, and self-control demands, IRR = 1.12, exhibited within-person associations with nighttime conduct problems over and above nighttime intoxication. Consistent with our hypothesis, daytime increases in self-control demands mediated the associations between daytime PTSD symptoms and subsequent nighttime conduct problems. The indirect effect between daytime PTSD symptoms and nighttime intoxication via self-control demands was nonsignificant. At the between-person level, self-control demands mediated the associations between PTSD symptoms and conduct problems; however, the expected between-person associations with intoxication were nonsignificant. Drinking behavior is related to but cannot fully account for various difficulties in psychosocial functioning associated with PTSD. The present results suggest that dysregulated behavior may, ironically, stem from individuals' concerted efforts to control and manage overwhelming symptoms. Self-control demands may be a common factor that accounts for a broad range of functional impairments associated with PTSD.

Nexus of despair: A network analysis of suicidal ideation among veterans.

The objective of this study was to estimate a network model of risk and resilience factors of suicidal ideation among veterans. Two network models of suicidal ideation among Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn veterans (N = 276) incorporated key disorders, traumatic stress, and resilience constructs to contextualize suicidal ideation. Childhood trauma was positively connected with suicidal ideation and harassment and inversely connected with social support and distress tolerance. This exemplifies long-lasting associations between childhood trauma and re-victimization, emotion regulation, and ability to form supportive social relationships. A subsequent model including lower-order facets indicated that combat trauma was predominantly associated with posttraumatic stress disorder-intrusion symptoms. This study highlights the importance of addressing both risk and resilience to reduce suicide risk among veterans and increases understanding of factors that contribute to suicidal ideation.

Temperament in the prediction of proximal versus distal expectancies: An acquired preparedness model.

In the acquired preparedness model of risk, alcohol expectancies mediate the association between personality and alcohol problems. In the current study, we tested the associations between temperament (i.e., effortful control and reactivity) and temperament-congruent expectancies of distal and proximal effects. It was hypothesized that effortful control would be inversely associated with drinking and problems and that these effects would be mediated through consequence expectancies. Alternatively, it was hypothesized that reactivity would be positively associated with drinking and problems and that these effects would be mediated by expectancies of immediate stimulation and attenuated sedation. This article presents data from a multiple group analyses with 483 young adults (76% female) from a university in the Midwest (n = 209) and Amazon's Mechanical Turk (n = 274). The hypotheses were partially supported. Reactivity was associated with expectancies of stimulation, which were associated with increased weekly drinking and problems. Reactivity was associated with increased weekly drinking and problems and this association was partially indirect through stimulating expectancies. Reactivity did not significantly predict sedating expectancies. The indirect effects from effortful control through consequence expectancies were not significant. There were curvilinear effects from consequence expectancies to drinking and problems. Specifically, the effect from consequence expectancies to drinking and problems was positive at low levels of expectancies, but became negative and significant at mean levels and above. Results of the invariance testing indicated that the model manifested similarly across university and MTurk respondents. These implications are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

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).

Affect and drinking behavior: Moderating effects of involuntary attention to emotion and distress tolerance.

This study tested a multiple group path model in a sample of young adults (n = 402; 233 university participant pool/169 Amazon MTurk) linking positive and negative affect to alcohol consumption and problems via enhancement and coping motives, respectively. Motivational models of alcohol use suggest that individuals drink in order to alleviate negative affective states or to enhance positive moods or feelings. Deficits in modulating attention toward emotional experience (i.e., involuntary attention to emotion [IAE]); and poor distress tolerance may contribute to maladaptive patterns of substance use (i.e., negative reinforcement). As negative affect increases, those with deficits in the ability to efficiently attend to emotions as well as the inability to withstand distress may seek more external means of regulating unwanted or intrusive emotional experiences via alcohol. It was hypothesized that involuntarily attending to one's emotions would contribute to negative reinforcement drinking and problems. Coping motives were directly associated with alcohol-related problems, while enhancement motives were directly associated with problems both directly and indirectly via alcohol consumption. The hypothesized interaction between negative affect and IAE to coping motives was conditional upon levels of distress tolerance, with the moderating effect of involuntary attention being significant at high but not low levels of distress tolerance. Distress tolerance exhibited direct, inverse associations with alcohol-related problems. This pathway was significant over and above the direct effects of both coping motives and alcohol consumption. This suggests that while tolerance for emotional distress may reduce negative reinforcement drinking, it also fosters adaptive regulation when intoxicated. (PsycInfo Database Record (c) 2020 APA, all rights reserved).