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Principal Investigator: Laura D Straus
Organization: VETERANS AFFAIRS MED CTR SAN FRANCISCO
Fiscal Year: 2024
Funding agency: Veterans Affairs
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.
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