Using Ecological Momentary Assessment to Examine Relationships Between Emotional Responding, Craving, and Substance Use, in Veterans with Posttraumatic Stress Disorder

Comorbid Posttraumatic Stress Disorder and Substance Use Disorder (PTSD-SUD) affects approximately one-third of Veterans. PTSD-SUD is associated with a host of deleterious outcomes including more severe symptoms, higher suicidality, and worse treatment outcomes. Thus, in order to improve healthcare for these high-risk Veterans, there is a critical need to better understand the mechanisms underlying PTSD-SUD. Both theoretical and empirical work suggest emotional responding, the intensity and duration of an emotional response to a trauma reminder, is one such mechanism. [For example, more intense and prolonged emotional responding predicts stronger cravings for substance use even when controlling for general negative affect. Thus, emotional responding appears to create a unique context for increased risk of substance use beyond general negative affectivity.] Adaptive mobile health interventions could be developed to target emotional responding and designed to deliver intervention to an individual in the moments of greatest risk for substance use. However, more work is needed to inform intervention development. Importantly, examinations of emotional responding have primarily been laboratory-based and have not examined the relationships between emotional responding and actual substance use. Thus, a critical expansion of this work will be to examine these dynamic relationships as they naturally unfold in the real world. Ecological momentary assessment (EMA) is an ideal methodological strategy to capture these time-varying relationships because it collects intensive longitudinal data (ILD) from individuals about their experiences throughout the day in real world contexts. The proposed Clinical Sciences Research and Development CDA-2 aims to examine mechanisms of PTSD-SUD using EMA. [This study has three primary aims: (1) test a hypothesized risk model of the relationships between emotional responding, craving, and substance use, (2) examine a predictive model of emotional responding and several other time-varying factors (e.g., distress tolerance, emotion regulation, and substance use motives) on substance use, and (3) gather qualitative research partner input to inform the development of a future adaptive mobile health intervention.] The study will recruit 125 Veterans to reach our final sample of 110. Participants will include Veterans with current PTSD-SUD and past month substance use. First, participants will complete a baseline research visit to assess eligibility. Eligible participants will complete an orientation in EMA using a VA-developed EMA app called mPRO. Next, they will complete a 30-day period of EMA. Participants will be asked to complete 4 EMA surveys each day: an initial survey and 3 pseudorandom signal-contingent surveys. Participants also have the option to self-initiate an event-contingent survey at any time if they experience a trauma reminder. At the end of weeks 1, 2, and 3, they will complete a short check-in visit. At the end of the EMA-monitoring period, participants will complete a follow up visit, which includes a feedback interview focused on gathering research partner input from Veterans and VA clinicians about their opinions and priorities for an adaptive mobile health intervention. Results from this CDA-2 will guide the development of a future adaptive mobile health intervention for Veterans with PTSD-SUD as part of a VA merit award. [By using ILD to better understand momentary mechanisms of PTSD-SUD, future interventions can target the factors that are most predictive of risk for substance use and provide greater access to more personalized approaches to healthcare.] In addition to the research aims, this CDA-2 will provide the applicant with focused training in advanced statistical methods for ILD, adaptive mobile health assessment and intervention (mHealth), the design and conduct of clinical trials, and professional development and grantsmanship. This training will be essential to facilitate th Project Number: 1IK2CX002799-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Lauren Rodriguez | Institution: PHILADELPHIA VA MEDICAL CENTER, PHILADELPHIA, PA | Activity Code: IK2 | Study Section: Special Emphasis Panel[ZRD1 NURA-U (01)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11043777