Examining Transdiagnostic Factors among Firefighters in Relation to Trauma Exposure, Probable PTSD, and Probable Alcohol Use Disorder

Mindfulness as a Moderator of the Association Between Anxiety and Alcohol Use Severity and Drinking Motives in Professional Firefighters

Objective: Firefighters are at risk of experiencing heightened anxiety and alcohol use perhaps due to occupational stress. Mindfulness is related to both anxiety and alcohol use; however, research on the relations of mindfulness with anxiety and alcohol use and drinking motives among firefighters is limited. This study examined (1) whether higher anxiety was positively related to alcohol use severity and drinking related motives (e.g., coping, enhancement, social, and conformity) and (2) whether higher mindfulness would moderate the association between anxiety symptom severity and alcohol use severity and alcohol use coping motives. Methods: Participants included urban firefighters (N = 679; Mage = 38.6; SD = 8.58; 93.5% male) who completed an online survey. Five hierarchical regression analyses were conducted to evaluate the main and interactive effects of anxiety symptom severity and mindfulness on all study outcomes (i.e., alcohol use severity and four drinking motives). Results: Anxiety symptom severity was significantly and negatively associated with mindfulness and, incrementally, positively associated with all alcohol use-related outcome variables. Mindfulness was negatively correlated with alcohol use severity and all alcohol use motives except social motives. Mindfulness moderated the effects of anxiety symptom severity on coping alcohol use motives only. Conclusion: Mindfulness moderated, or attenuated, the positive association between anxiety symptom severity and coping-oriented alcohol use motives among professional firefighters. Results have the potential to inform treatment development and wellness programming for the fire service.

The association between PTSD symptom clusters and religion/spirituality with alcohol use among first responders

Alcohol misuse and posttraumatic stress disorder (PTSD) co-occur at high rates among first responders (e.g., law enforcement, firefighters, paramedics), underscoring the need to better understand these relations to inform intervention efforts. Identifying malleable processes relevant to the association between PTSD and alcohol among first responders could inform tailored interventions. An example of such a malleable process is spirituality. As such, the current study examined the unique relationships between PTSD symptom clusters and alcohol misuse, while also accounting for the role of select demographics and religion/spirituality, in a sample of first responders. A national online sample of first responders (N = 320) completed measures of PTSD symptomology, alcohol misuse, religion/spirituality and demographics. Hierarchical linear regression analyses revealed that PTSD Intrusion (Cluster B) symptom severity was associated with greater alcohol misuse and PTSD Avoidance (Cluster C) was associated with lower alcohol misuse. Additionally, positive and negative spiritual coping were also associated with alcohol misuse. In the context of similar research among military samples, findings suggest potentially unique associations between PTSD symptom clusters and alcohol misuse among first responders. Additionally, findings highlight the potentially protective role of religion/spirituality in this population. Future research should explore nuanced relationships between PTSD symptom clusters and alcohol misuse as well as the salience of spirituality/religion in this unique population.

Emotional dysregulation in relation to substance use and behavioral addictions: Findings from five separate meta-analyses

Background/objective

Emotional dysregulation (ED) is a transdiagnostic variable underlying various psychiatric disorders, including addictive behaviors (ABs). This meta-analysis examines the relationship between ED and ABs (alcohol, tobacco, cannabis, gambling, and gaming), and indicators of AB engagement (frequency, quantity/time of use, severity, and problems).

Method

Searches were conducted in PubMed, Scopus, WoS, and PsycINFO. Five separate meta-analysis were run using random-effects models. Moderators (age, sex, continental region, and sample type; community vs. clinical), and publication bias were evaluated.

Results

A total of 189 studies (N = 78,733; 51.29 % women) were identified. ED was significantly related to all ABs. Problems and severity indicators exhibited the largest effects (r's .118-.372, all p <.023). There were larger effect sizes for cannabis problems (r = .372), cannabis severity (r = .280), gaming severity (r = .280), gambling severity (r = .245), gambling problems (r = .131), alcohol problems (r = .237), alcohol severity (r = .204), and severity of nicotine dependence (r = .118). Lack of impulse control exhibited some of the largest effects in relation to ABs. Clinical samples of cannabis users vs. community-based exhibited larger magnitude of associations.

Conclusions

Interventions targeting ABs should address lack of strategies and impulsive behaviors as an emotion regulation strategy specifically, as it is a common risk factor for ABs.

Transdiagnosis of alcohol use and psychopathologies: A systematic review

Multiple diagnoses are the rule in Mental Health and alcohol use disorder (AUD) is a psychopathology with many comorbidities, requiring interventions that consider common factors, which means using a transdiagnostic perspective. This study aimed to identify in the scientific literature the main common transdiagnostic factors that link AUD to other psychopathologies in people over 18 years of age. A systematic review of the literature was carried out in the portals of the databases Pubmed, PsychINFO and CAPES. 37 articles were selected for analysis, which resulted in 25 transdiagnostic factors linked to AUD and to several other related disorders and health conditions. The results emphasize the variety of disorders and health conditions related to AUD, which highlights the importance of transdiagnostic factors for these conditions as targets for both scientific research and therapeutic interventions for this population.

Spiritually Integrated Group Psychotherapy for First Responders: Forgiveness, Trauma, and Alcohol Use

First responders (e.g. firefighters, law enforcement, paramedics, corrections officers) experience high rates of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Despite the relevance of both spirituality and forgiveness to PTSD and AUD among first responders, spiritually integrated group interventions for this population are rare. This article discusses a forgiveness session of a spiritually integrated group psychotherapy protocol for first responders (SPIRIT-FR) in acute psychiatric care. This brief group psychotherapy intervention includes (a) psychoeducation about the intersection of PTSD, AUD, and forgiveness (b) discussion of the relevance of forgiveness to PTSD and AUD, and (c) the integration of spiritual beliefs and behaviors to move toward forgiveness. We discuss relevant clinical theory as well as the potential clinical application of this protocol.

PTSD Symptom Severity and Alcohol Use among Firefighters: The Role of Emotion Regulation Difficulties

OBJECTIVE

Heightened rates of posttraumatic stress disorder (PTSD) symptoms and alcohol use have been documented among firefighters. Emotion regulation difficulties (ERD) are clinically relevant to both PTSD and alcohol use. Few studies have examined the role of ERD in the association of PTSD symptoms with alcohol use severity and alcohol use motives among firefighters. Thus, the present investigation examined the indirect effect of PTSD symptom severity on alcohol use severity and alcohol use motives through ERD.

METHODS

The sample was comprised of 685 firefighters (Mage = 38.65, SD = 8.57, 93.6% male) recruited from an urban fire department in the southern U.S. to complete an online survey. Indirect effects were calculated using 10,000 bootstrapped samples. Effects were examined after accounting for years of fire service, occupational stress, trauma load (i.e., number of traumatic event types experienced); in models evaluating alcohol use motives as outcomes, other alcohol use motives (i.e., alternate motives subscales) were included as additional covariates.

RESULTS

First, ERD explained the association of PTSD symptom severity with alcohol use coping motives (β = .01, SE = .003, 95% CI [.004-.01]). Furthermore, ERD did not significantly account for the association of PTSD symptom severity with alcohol use severity (β = .02, SE = .01, 95% CI [-.004-.04]), alcohol use enhancement motives (β = -.003, SE = .002, 95%CI [-.007-.000]), alcohol use social motives (β = .004, SE = .002, 95% CI [-.000-.01]), or alcohol use conformity motives (β = -.002, SE = .002, 95% CI [-.006-.02]).

CONCLUSIONS

Results demonstrated that, among firefighters, PTSD symptom severity is positively related to alcohol use coping motives through heightened ERD. Clinical implications and future directions are discussed.

Transdiagnostic Processes Linking Posttraumatic Stress Disorder Symptoms to Alcohol Use Severity

Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.

Trauma Exposure and Suicidal Ideation among Korean Male Firefighters: Examining the Moderating Roles of Organizational Climate

Background

This study investigated the relationship between trauma exposure and suicidal ideation. Moreover, this study examines the moderating roles of organizational climate on the association between trauma exposure and suicidal ideation in Korean male firefighters.

Methods

A total of 15,104 male firefighters who completed a questionnaire were analyzed. The data were obtained using an online self-administered questionnaire from the Firefighter Research on Enhancement of Safety and Health Study. Poisson regression analysis was performed to determine the effects of trauma exposure on suicidal ideation and the moderating effect of organizational climate.

Results

The results showed that 389 firefighters (2.6%) responded that they had experienced suicidal ideation. In the final model, trauma exposure was positively related to suicidal ideation (adjusted risk ratio [aRR], 1.076; 95% confidence interval [CI]: 1.051-1.103), and organizational climate was negatively associated with suicidal ideation (aRR, 0.772; 95% CI: 0.739-0.806). Additionally, the interaction term (trauma exposure × organizational climate) was related to suicidal ideation (aRR, 1.016; 95% CI: 1.009-1.023).

Conclusions

This study suggests that trauma exposure might play a significant role in developing suicidal ideation and that positive organizational climate moderates the negative effects of trauma exposure on suicidal ideation among firefighters. It is necessary to perform a follow-up study of various intervention strategies to maintain a healthy organizational climate or work environment. Such interventions should promote lasting trust within teams, provide social support and belonging, and nurture job value.

Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis

BACKGROUND

Distress tolerance (DT) has received increased attention in recent years due to its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology.

METHODS

A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, and BPD symptomatology. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender.

RESULTS

DT shared significant, negative, medium correlations with PSU (r = -.18,), DEB (r = -.20), and BPD symptomatology (r = -.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships.

LIMITATIONS

The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures.

CONCLUSIONS

The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.

Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis

The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants (M_age = 29.96, SD = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude (r = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.