Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name





Denise Hien

Subject Categories

Clinical Psychology


emotion dysregulation; posttraumatic stress disorder; prolonged exposure; substance dependence


Trauma has been shown to disrupt self-regulatory processes; emotion regulation deficits have also been implicated in the initiation and maintenance of substance use disorders (SUDs). Treatments for these complex comorbid problems utilize a variety of approaches. However, to date, few studies have examined the effect of various available treatments on emotion dysregulation in this population. This study extends the research on emotion regulation among the population with comorbid posttraumatic stress disorder (PTSD) and SUD. This study is a secondary analysis of part of the data from a randomized clinical trial assessing the relative efficacy of two active treatment conditions for substance dependent individuals who also meet criteria for current DSM-IV-TR PTSD. The current study examined features associated with emotion dysregulation, correlating dysregulation with PTSD and SUD symptoms; the study focused on baseline emotion dysregulation as a predictor of treatment outcomes. Additionally, the study examined emotion dysregulation over time to determine the mutability of this complex factor in response to treatment. Lastly, this study utilized a case illustration to examine in more depth change in emotion dysregulation over time, as measured by physiological arousal; this methodology provides for a more thorough depiction of the phenomenon. Correlation analyses identified that baseline emotion dysregulation was associated with baseline PTSD symptom severity, but not with baseline substance use frequency among those with comorbid PTSD and SUD. A repeated measures ANOVA determined that the high baseline dysregulation group that received relapse prevention treatment showed no change in substance use frequency from baseline to follow-up. Additionally, the high baseline dysregulation group that received Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) showed a trending decrease in dysregulation at follow-up. Altogether, this exploratory study provided evidence that exposure therapy can be tolerated by and beneficial to highly dysregulated persons with both PTSD and SUD and that psychotherapy focusing only on substance used may be contraindicated for highly dysregulated individuals with comorbid PTSD and SUD.