Priya K. Johal

South Asian Americans, one of the largest immigrant groups in the United States, experience trauma and engage in risky behaviors. South Asian Americans may face cultural pressures to suppress positive affect, which could explain the association between posttraumatic stress disorder (PTSD) and risky behaviors. This study used associational variable analysis to examine whether PTSD symptom severity was associated with risky behaviors and if affective responses to positive events explained variance in this association. South Asian American adults who were exposed to trauma ( N = 244; M _age = 34.26 years, SD = 8.60; 54.9% men) were recruited through Amazon Mechanical Turk. Three multivariate linear regressions were conducted, each modeling PTSD symptoms, risky behaviors, and one affective response (i.e., positive emotionality, hedonic deficits, or negative affect interference), controlling for age and gender. Significant models were probed for indirect associations. Many participants met the criteria for probable PTSD (48.0%) and engaged in at least one past‐month risky behavior (79.0%), including problematic technology use, eating behaviors, and alcohol use (55.7%–60.2%). PTSD symptom severity was positively associated with engagement in risky behaviors, R ² = .79, p < .001, and indirect effects were significant via hedonic deficits, β = .07, bootstrapped 95% CI [.03, .12], and negative affect interference, β = .24, bootstrapped 95% CI [.12, .37]. Findings suggest that PTSD symptoms among South Asian Americans may reflect difficulties in experiencing and sustaining positive affect, which may contribute to risky behaviors. Trauma interventions targeting compromised affective responses may reduce risky behaviors in this population.

Opioid use disorder (OUD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, there are no psychotherapy treatments intentionally designed for this comorbidity, nor designed to be augmented with medications for OUD. In this open-label pilot trial, we tested Helping Opioid Use Disorder and PTSD with Exposure (HOPE), a novel integrated, trauma-focused treatment for individuals (N = 6) with OUD/PTSD who were stabilized on medications for OUD. HOPE was delivered weekly for 10–12 sessions, and one follow-up visit was conducted ~1-month post-treatment. Primary outcomes included urine drug screens, the Timeline Followback, Desire for Drugs Questionnaire, Clinician-Administered PTSD Scale-5 (CAPS-5), and PTSD Checklist-5 (PCL-5). Boot-strapped linear mixed effect models and generalized estimating equations showed that PTSD symptoms (CAPS-5: B = −7.16, SE = 1.24, p < 0.01; PCL-5: B = −2.04, SE = 0.26, p < 0.01), desire for opioids (B = −0.56, SE = 0.15, p < 0.01), depression symptoms (B = −0.43, SE = 0.09, p < 0.01), and anxiety symptoms (B = −0.50, SE = 0.08, p < 0.01) decreased significantly over time. Client satisfaction increased throughout the study (B = 0.18, SE = 0.08, p = 0.02), and 83.3% of participants completed the therapy and follow-up visit. There were no significant changes in opioid or other substance use from baseline to follow-up. Although preliminary, results show high acceptability and feasibility of the HOPE therapy and demonstrate significant improvements in PTSD and associated symptoms with an integrated, trauma-focused treatment.