Examining the Relationship between Negative Affect and Posttraumatic Stress Disorder Symptoms Among Smokers Using Ecological Momentary Assessment

Abstract Background Posttraumatic stress disorder (PTSD) and negative affect (e.g., anger, depression, anxiety), are highly co-occurring. It remains unclear whether changes in PTSD symptoms subsequently impact negative affect, or vice versa. This study assessed associations between moment-to-moment PTSD symptoms and negative affect in a sample of smokers with PTSD to determine directionality of this relationship. Methods Participants ( N  = 125) enrolled in two smoking cessation studies with co-occurring PTSD and cigarette use completed measures of PTSD and negative affect. Ecological momentary assessment (EMA) methodology was used to record symptoms during a one-week baseline period, during which participants smoked ad lib . Cross-lagged path analyses assessed PTSD symptoms and negative affect for directionality of their relationship, controlling for whether an EMA reading was smoking or non-smoking. Path analyses examined the lagged associations between PTSD symptoms and negative affect. Results Results found PTSD symptom severity at T-1 was significantly related to negative affect levels at time T, but negative affect at time T-1 was not associated with PTSD symptom severity at time T. Results indicated the model retaining the cross-lagged effect of PTSD symptom severity on negative affect provided better fit to the data than other models. Limitations Limitations included use of self-report data, brief measures of symptoms, participants already had PTSD and/or MDD, participants were recruited from a specific clinical population, and use of DSM-IV data. Conclusions Results suggest PTSD symptoms drive day-to-day fluctuations in negative affect, and highlight the importance of evaluating negative affect in the treatment of PTSD.