Date of Degree

9-2019

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Eric A. Fertuck

Committee Members

Lesia M. Ruglass

Kevin B. Meehan

Kathryn M. Z. Smith

Robert Melara

Subject Categories

Clinical Psychology | Psychiatric and Mental Health | Substance Abuse and Addiction

Keywords

rejection sensitivity, cannabis use, social exclusion, young adults, ecological momentary assessment, Cyberball

Abstract

Cannabis has been implicated in relieving distress and social pain, an important area of research in young adult samples, given the saliency of peer and social networks to addiction. Cannabis, via opioid pathways, has been shown to reduce, or potentially buffer, the effects of social pain and rejection. Thus, cannabis may be protective against the painful feelings of social stress, particularly for heavier or more frequent users. However, findings are not wholly positive, as other research indicates cannabis may blunt affective responses and impair social processing. The effects of cannabis use in young adults are understudied, as well as its relationship to rejection sensitivity (RS). In this translational pilot study, we investigated the relationship between RS, social rejection, and cannabis use in moderate (using 1-3 times per week; n = 21) and heavy (using 4 or more times per week; n = 25) young adult cannabis users, compared to healthy controls (no cannabis use in past year; n = 24); rejection was longitudinally assessed at three levels: self-report, experimental, and daily diaries completed in naturalistic settings.

Seventy college-aged (M = 20.56, SD = 3.13) completed self-report measures assessing trait RS and cannabis use factors. Cyberball+, a laboratory-based manipulation of social exclusion that varies the rates of inclusion, was employed to investigate whether RS and cannabis use frequency influenced rejection distress to social exclusion. Ecological momentary assessment (EMA) in the form of an online daily diary delivered via text message prompts and completed four times per day over the course of seven days was used to assess factors related to cannabis use and craving in real-world settings. Multi-level regression models were used to predict real-world cannabis craving and use from experimental and ecological experiences of rejection.

Results showed that while there were no significant group differences between moderate, heavy users, or controls on trait RS, controls reported significantly higher scores of the expectancy component of trait RS, reflecting the expectation of rejection may be more salient than the anxious rumination component and may maintain the fear that rejection will occur. A non-significant correlation between trait RS and rejection distress to social exclusion indicated these may be two distinct constructs where the former is related to emotional responses to rejection while the latter is associated with a greater desire for social attachment and a need to belong. In contrast to our hypothesis, trait RS and cannabis use frequency had no significant interaction effect on rejection distress. Notably, cannabis users reported a significantly greater increase in craving cannabis to achieve relief from negative mood and in anticipation of a positive outcome after social exclusion. Lastly, while experiences of real-world rejection were low during the one-week EMA period, heavy cannabis users reported more instances of rejection than moderate users. Results from mixed effects logistic regression models show increased rejection distress to experimental social exclusion is significantly associated with reduced odds (45%) of real-world cannabis craving but not use, while real-world experiences of rejection was not associated with craving or use.

To our knowledge, this study is the first to assess RS's relation to cannabis use and to provide converging evidence that experimentally induced rejection distress influences and is prospectively predictive of reduced real-world cannabis craving. Findings from this study have important research and clinical implications and can provide guidance for identifying and treating cannabis use and its related problems on college campuses. Clinicians would benefit from incorporating evaluating the impact of RS on traditional psychotherapy treatments. Results can inform the development of EMA and text-messaging based interventions as a tool for targeted, real time substance use treatment, particularly for young adult cannabis users.

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