Alcohol-involved sexual aggression: Emotion regulation as a mechanism of behavior change.

Objective: Sexual aggression remains a significant public health problem, with the majority of sexual assaults involving alcohol. Founded upon an experimental medicine approach to behavior change, the current study used a proximal change experiment to target and test emotion regulation (ER) as a mechanism underlying alcohol-involved sexual aggression. Method: Heavy episodic drinking men aged 21–30 with a sexual assault perpetration history (N = 209) were randomly assigned to a brief, online, ER-focused cognitive restructuring or mindfulness intervention or to control. Intervention effects were evaluated during sober and intoxicated states through laboratory-based alcohol administration (target BrAC = .08%). Intoxicated and sober participants completed a proximal change protocol that included implementing ER skills during a sexual aggression analogue that assessed relevant emotions and intentions. Results: Path analysis demonstrated that relative to control, the cognitive restructuring intervention improved emotional modulation and emotional clarity, resulting in lower sexual arousal and anger, respectively, followed by decreased sexual coercion intentions. The mindfulness intervention yielded mixed results, predicting decreased sexual aggression intentions compared to control but also predicting stronger coercive tactic intentions in intoxicated men with more severe sexual aggression histories. Both interventions improved emotional acceptance relative to control, but only for sober men. Conclusions: Overall, the current study demonstrated that ER-focused interventions improved proximal ER skills associated with reduced sexual aggression intentions, signifying ER as an important mechanism for changing sexually aggressive behavior. Because intervention efficacy varied by intoxication state, further research is needed to assess the effectiveness of ER interventions targeting real-world alcohol-involved sexual aggression.