Examining the Effect of Sleep Disruption on Emotion Regulation and Trauma-Related Symptoms in Veterans

检查睡眠中断对退伍军人情绪调节和创伤相关症状的影响

• 批准号: 10417019
• 负责人: Laura D Straus
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10417019
• 关键词: Acute; Affective; Biological Process; Clinical; Cohort Studies; Cross-Sectional Studies; Data Reporting; Development; Diagnostic; Disease; Distress; Emotional; Emotions; Evidence based treatment; Goals; Gold; Image; Impaired cognition; Impairment; International; Intervention; Laboratories; Link; Literature; Longitudinal Studies; Maintenance; Measures; Mental Health; Methods; Modeling; Nightmare; Participant; Patient Self-Report; Patients; Pharmacology; Post-Traumatic Stress Disorders; Process; Questionnaires; REM Sleep; REM Sleep Deprivations; Randomized; Recording of previous events; Reporting; Research; Research Personnel; Risk Factors; Role; Sampling; Severities; Sleep; Sleep Deprivation; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Sleeplessness; Slow-Wave Sleep; Stimulus; Symptoms; System; Testing; Time; Training; Trauma; Validation; Veterans; active control; base; career; cognitive reappraisal; cohort; design; effective intervention; emotion regulation; evidence base; experimental study; imaging system; indexing; longitudinal analysis; modifiable risk; physical conditioning; poor sleep; post-traumatic symptoms; psychosocial; recruit; response; sleep quality; sleep regulation; trauma exposure

Posttraumatic Stress Disorder (PTSD) is common in Veterans and associated with a number of negative physical and mental health consequences. While evidence-based pharmacological and psychosocial interventions for PTSD have been developed, not all patients respond fully to treatment. Investigating the biological processes involved in the development and maintenance of PTSD will increase understanding of the disorder and aid in the development of more effective interventions. Sleep disruption, particularly Rapid Eye Movement (REM) sleep disruption, is a potent and modifiable risk factor contributing to PTSD. For example, longitudinal studies have shown REM sleep fragmentation in the acute aftermath of trauma predicts PTSD symptoms at a later timepoint, underscoring the potential importance of sleep as a mechanism in PTSD. Recent research has also demonstrated an association between poor sleep and impaired emotion regulation. Specifically, research suggests disrupted sleep impairs effective emotion regulation strategies, such as cognitive reappraisal, while increasing reliance on more maladaptive emotion regulation strategies, such as expressive suppression. For example, previous studies have shown poor sleep at baseline predicts impaired cognitive reappraisal in lab-based tasks involving emotionally provocative stimuli. Our research group has also demonstrated that poor self-reported global sleep quality is associated with reduced cognitive reappraisal and increased reliance on expressive suppression when measured at one timepoint in a large group of Veterans with and without PTSD. The implications of this finding are particularly salient for patients with PTSD, because maladaptive emotion regulation contributes to severity of trauma-related symptoms, increases distress, and interferes with gold-standard interventions for PTSD. However, most research linking disrupted sleep to impaired emotion regulation has been conducted in healthy controls, or at only one time-point in clinical samples. Therefore, additional research is necessary to provide support for a hypothesized model whereby disrupted sleep contributes to maladaptive emotion regulation, thus in turn maintaining trauma-related symptoms. This study responds to these gaps in the literature by using both self-report longitudinal measures and an experimental sleep manipulation to test the hypothesis that disrupted sleep contributes to maladaptive emotion regulation in Veterans with and without PTSD. The first aim of the study will be to examine whether poor sleep at one timepoint predicts maladaptive emotion regulation and trauma-related symptoms at subsequent timepoints in a large cohort of Veterans with and without PTSD. The Insomnia Severity Index (ISI), the Emotion Regulation Questionnaire (ERQ), and the PTSD Checklist (PCL) will be measured at three timepoints in this cohort. We hypothesize that poor sleep at the first timepoint will predict reduced reappraisal, increased expressive suppression, and increased severity of trauma-related symptoms at the subsequent timepoints. The second portion of the proposed project will build upon these findings by experimentally testing the notion that disrupted sleep results in impaired emotion regulation, and will also directly test the hypothesis that REM sleep specifically is tied to emotion regulation processes. A sample of Veterans (n = 60) with and without PTSD will be recruited and randomized to undergo one of three sleep conditions: 1) one night of REM sleep deprivation (REMD), 2) one night of slow-wave sleep deprivation (SWSD, an active control condition), or 3) one night of normal sleep. Participants will then participate in two laboratory emotion reappraisal tasks using images from the International Affective Picture System (IAPS). We hypothesize that participants in the REMD group will rate the images more negatively during a cognitive reappraisal task than SWSD group or the normal sleep group, and will also be more likely to choose expressive suppression than reappraisal on an emotion regulation choice task. Exploratory analyses will determine if this effect differs by diagnostic group status.

创伤后应激障碍（PTSD）在退伍军人中很常见，并且与许多负面有关 身心健康后果。而基于证据的药理学和社会心理 已经开发出对PTSD的干预措施，并非所有患者对治疗做出反应。调查 PTSD的开发和维护涉及的生物过程将增加对 障碍和有助于开发更有效的干预措施。睡眠中断，特别快的眼睛 运动（REM）睡眠破坏是导致PTSD的有效且可修改的危险因素。例如， 纵向研究表明，在创伤的急性后，REM睡眠碎片预测PTSD 稍后的时间点的症状，强调睡眠作为PTSD的机制的潜在重要性。 最近的研究还表明，睡眠不良与情绪调节受损之间存在关联。 具体而言，研究表明，睡眠破坏会损害有效的情绪调节策略，例如 认知重新评估，同时增加了对不良适应性情绪调节策略的依赖，例如 表达抑制。例如，以前的研究表明，基线时的睡眠不佳预测受损 认知重新评估在涉及情感挑衅刺激的基于实验室的任务中。我们的研究小组也有 证明自我报告的全球睡眠质量差与认知重新评估的降低有关 当在一大群退伍军人中，在一个时间点测量时，会增加对表达抑制的依赖 有和没有PTSD。这一发现的含义对于PTSD患者特别重要，因为 适应不良的情绪调节会导致与创伤相关症状的严重程度，增加困扰和 干扰PTSD的金标准干预措施。但是，大多数将干扰睡眠与 情绪受损是在健康对照中进行的，或者仅以临床时间的一个时间点进行 样品。因此，为了为假设的模型提供支持，需要进行其他研究 破坏的睡眠有助于适应不良的情绪调节，从而维持与创伤有关的 症状。这项研究通过使用两种自我报告纵向措施来应对文献中的这些差距 并进行了实验性睡眠操纵，以测试破坏睡眠导致不良适应性的假设 有和没有PTSD的退伍军人的情绪调节。该研究的第一个目的是检查是否是否 一次时间点睡眠不良预测适应不良的情绪调节和与创伤有关的症状 随后的时间点，在有和没有PTSD的大量退伍军人队列中。失眠严重程度指数（ISI）， 情绪调查问卷（ERQ）和PTSD清单（PCL）将以三个 该队列中的时间点。我们假设第一个时间点睡眠不佳将预测重新评估的减少， 随后的表达性抑制增加，与创伤相关症状的严重程度增加 时间点。拟议项目的第二部分将通过实验测试以这些发现为基础 破坏睡眠的观念会导致情绪调节受损，也将直接检验假设 REM睡眠特别与情绪调节过程有关。带有的退伍军人样本（n = 60） 如果没有PTSD，将被招募并随机进行以下三种睡眠条件之一：1）REM一晚 睡眠剥夺（REMD），2）慢波睡眠剥夺（SWSD，主动控制条件）或 3）正常睡眠一晚。然后，参与者将使用两个实验室情绪重新评估任务 来自国际情感图片系统（IAP）的图像。我们假设恢复的参与者 在认知重新评估任务期间，小组将比SWSD组或正常人对图像进行更负面的评价 睡眠组，也将更有可能选择表现力的抑制，而不是在情感上重新评估 监管选择任务。探索性分析将确定这种效果是否因诊断组状态而有所不同。