Dynamic bidirectional relationships between perceived stress and emotion regulation in emergency medical service clinicians

Emergency medical services (EMS) clinicians are first responders who experience recurrent occupational stressors. Cross-sectional research suggests that higher self-regulation of emotions may be related to lower stress, especially in individuals with regular substance use. However, temporal dynamics are unclear. Our objective was to identify real-time dynamics between perceived stress and emotion regulation in EMS clinicians who regularly use substances. Participants were full-time EMS clinicians reporting alcohol and/or cannabis use ≥2x/week. Participants completed five daily ecological momentary assessments (EMAs) at semi-random times for 28 days. We used a continuous-time structural equation model with Bayesian estimation to identify dynamics between perceived stress and emotion regulation (both within-person centered and standardized). The 110 participants completed 12,234 EMAs (81.3% adherence). Higher perceived stress predicted lower future emotion regulation (standardized estimate = -0.68 [-1.05, -0.31]). Inversely, higher emotion regulation predicted lower future perceived stress (standardized estimate = -2.25 [-3.38, -1.15]). We identified bidirectional relationships between perceived stress and emotion regulation in the daily lives of EMS clinicians with regular substance use. While results may not be generalizable to EMS clinicians who do not regularly use substances, we identified emotion regulation as a future interventional target to reduce real-time stress in this highest-risk group.