PTSD, emotional regulation and substance use: the SSA talks to Alice Bowen
Alice Bowen was recently awarded an SSA PhD Studentship. Her PhD is due to start in October 2021 and will focus on Post-Traumatic Stress Disorder, emotional regulation and substance use. In late June 2021, we caught up with Alice to find out more.
SSA: What will your PhD study?
Alice: “The project looks at the role of emotional regulation in adults with substance use disorder, Post-Traumatic Stress Disorder (PTSD) and experience of interpersonal violence. Rates of interpersonal violence – that includes emotional, physical or sexual violence in childhood or adulthood – and rates of PTSD are high among people with substance use disorder. Co-occurring PTSD and substance use are associated with adverse outcomes including increased rates of relapse, overdose and suicide. So, there’s still a need to develop effective interventions for that group.
One approach to that is looking at factors that contribute to both disorders. One of these factors is emotional regulation. This involves the process of identifying, evaluating and modulating your own emotions. Difficulties with emotional regulation have been consistently associated with PTSD and with substance use disorders; therefore, it might be a useful focus for interventions.
Evidence suggests that social factors and gender might be important when looking at how people regulate their emotions, but that’s not really been explored in this population. Also, the majority of research in the area has been quantitative and cross-sectional. My study is a longitudinal qualitative study and the aim is to look at change over time and to look at how social factors, gender and other things might be involved with changes in emotional regulation, substance use and PTSD symptoms. I plan to focus on service users’ perspectives and their experiences.”
Is this a qualitative study? How many people are you hoping to follow?
“The plan is to conduct a systematic review first looking at the role of emotional regulation in people with substance use disorder, PTSD and experience of interpersonal violence. I’ll then use the findings to inform the longitudinal qualitative study. I hope to follow 30 people: on entrance to the study and then 6 months and 12 months later. People can be at any stage of treatment and it might be possible to look at differences depending on what stage of treatment they’re at. So yes, 30 people, recruitment might be quite challenging (laughs). But I have a good chunk of the timeline to recruit people.”
What first made you interested in this area of study?
“I’ve always had an interest in the impact of trauma on mental health and addiction and in co-occurring mental health problems and substance use. I did psychology as an undergraduate degree and I guess that’s where the interest came from. After I graduated, I worked in a substance use treatment service in Leeds, which is where I’m from. It was learning about people and their experiences and the really high rates of trauma within services and how it had impacted people’s lives that made me want to study this further, and hopefully contribute to better support for these people.”
So, you have an undergraduate degree in psychology, a masters in mental health and experience working in an addiction treatment centre. How did these experiences differ or complement each other?
“I think that working in services shows a much more realistic picture of the treatment’s that are actually available and of people’s experiences. I think the academic side of things complements this by looking at the underlying theory behind certain approaches and treatments. There was some teaching on addiction during my masters and I learned a lot about different mental health problems, including their underlying causes and treatments. I think I then really developed my understanding of addiction from an academic perspective when I started working as a Research Assistant at The National Addiction Centre, at King’s. I’ve also worked closely with service users in this role, which has taught me so much and I think brings together the academic side of things with peoples lived experience.”
Did you then go straight to working in King’s College London when you finished your masters?
“Yes, I worked part-time at King’s in a clinical academic team whilst I was doing my masters. I supported the clinical team who worked with people with treatment resistant psychosis and did some research about the service. So, that was an economic and clinical evaluation of the service. After I finished my masters, I stayed at that job a little bit longer and then I came over to the addictions department and have been there for, it will be 3 years in October.”
What have you been working on since then?
“I’ve been working on a collaborative project in the addictions department for the past 3 years, developing the SURE Recovery app. When I came on board it was at the point when Jo [Professor Jo Neale] was planning to develop a recovery app alongside people in recovery. We worked with a digital developer called Mindwave Ventures, and started by doing some interviews and workshops with people who were at different stages in recovery or treatment. They told us about their experiences, what they would like to see in a recovery app and how it might look and what we might include.
I worked with Mindwave who built the back end of the app based on these interviews and workshops, while we developed the content alongside people with lived experience of addiction. We then tested the app with people in recovery and launched it in 2019. Since then, we’ve been disseminating the app as much as we can, so for example through services and online. At the moment we’re building a service user network across the country of people who are enthusiastic about the app and are able to talk about it to other people who might find it useful.
I’m also working on a qualitative study looking at people who have used the app. I talked to them about their experiences of using it, how it was helpful and how it could be improved, what they liked and didn’t like. So, we’ve just analysed that data and are writing it up for publication at the moment.”
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