Anxiety sensitivity as a prospective predictor of alcohol use disorders

Trait Emotional Intelligence, Anxiety Sensitivity, and Experiential Avoidance in Stress Reactivity and Their Improvement Through Psychological Methods

Stress pervades daily society, often with deleterious consequences for those prone to react intensely to it. Intervention techniques to attenuate stress reactivity are thus paramount. With that goal in mind, researchers have sought to identify and alter malleable psychological dispositional variables that influence stress reactivity. Trait emotional intelligence (TEI), anxiety sensitivity (AS), and experiential avoidance (EA) are increasingly receiving attention in these research efforts. The self-reported emotional component of stress reactivity has been emphasized in investigations and is our focus. Specifically, this paper overviews the role of TEI, AS, and EA in self-reported stress responses. We also discuss empirically supported psychological methods to adjust suboptimal levels of these variables in normal populations. Both psycho-educational (information, skills) and mindfulness-based interventions (specific mindfulness therapies or components) are covered. Findings include that (1) TEI, AS, and EA are each correlated with the emotional component of stress reactivity to both naturalistic and lab-based stressors; (2) preliminary support currently exists for psycho-educational intervention of TEI and AS but is lacking for EA; (3) adequate evidence supports mindfulness-based interventions to target EA, with very limited but encouraging findings suggesting mindfulness methods improve TEI and AS; and (4) although more research is needed, stress management approaches based on mindfulness may well target all three of these psychological variables and thus appear particularly promising. Encouragingly, some methods to modify dispositional variables (e.g., a mindfulness-based format of guided self-help) are easily disseminated and potentially applicable to the general public.

Are there reciprocal relationships between substance use risk personality profiles and alcohol or tobacco use in early adolescence?

AIM

We examined whether reciprocal relationships were present between the SURPS personality profiles and substance use in early adolescence.

METHODS

Longitudinal data of four-waves of a broader effectiveness study were used from 1068 early adolescents.

RESULTS

Our cross-lagged models indicated that sensation seeking and impulsivity show strongest reciprocal associations with substance use during early adolescence. In contrast, no reciprocity was present between substance use and anxiety sensitivity and only one reciprocal relationship was present between substance use and hopelessness.

CONCLUSIONS

In trying to prevent early adolescents from alcohol and tobacco use, it might be of key importance to acknowledge the mutual influence between certain personality profiles and substance use. Specifically, sensation seeking and impulsivity are relevant during early adolescence and awareness of early adolescents' vulnerability for these personality predispositions is warranted.

Distress tolerance and anxiety sensitivity cognitive concerns: testing the incremental contributions of affect dysregulation constructs on suicidal ideation and suicide attempt

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on suicidal ideation and prior attempts. The current study sought to better elucidate the nature of these relationships by examining AS, DT, and suicidal ideation and attempt in a clinical sample (N=192). Consistent with prior work and prediction, findings revealed a significant relationship between the AS cognitive concerns subfactor and suicidal ideation and suicide attempt history after accounting for the effects of DT, gender, and depressive symptoms. In addition, depressive symptoms significantly moderated the relationship between the AS cognitive concerns subfactor and suicidal ideation. After accounting for the influence of AS, analyses revealed that DT approached significance in predicting suicidal ideation, but did not significantly predict suicide attempt history. These results suggest that elevated AS cognitive concerns are particularly relevant to suicide in the context of depressive symptoms. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns.

Hazardous drinking, depression, and anxiety among sexual-minority women: self-medication or impaired functioning?

OBJECTIVE

Sexual-minority women are at heightened risk for a number of mental health problems, including hazardous alcohol consumption, depression, and anxiety. We examined self-medication and impaired-functioning models of the associations among these variables and interpreted results within a life course framework that considered the unique social stressors experienced by sexual-minority women.

METHOD

Data were from a sample of 384 women interviewed during the first two waves of the Chicago Health and Life Experiences of Women (CHLEW) study.

RESULTS

Covariance structure modeling revealed that (a) consistent with a self-medication process, anxiety was prospectively associated with hazardous drinking and (b) consistent with an impaired-functioning process, hazardous drinking was prospectively associated with depression.

CONCLUSIONS

Our findings support a life course perspective that interprets the mental health of adult sexual-minority women as influenced by adverse childhood experiences, age at drinking onset, first heterosexual intercourse, and first sexual identity disclosure, as well as by processes associated with self-medication and impaired functioning during adulthood.

Prospective evaluation of the effect of an anxiety sensitivity intervention on suicidality among smokers

Recent empirical work has revealed a significant relationship between anxiety sensitivity (AS), particularly the AS cognitive concerns subfactor, and suicidality among cigarette smokers. The current study prospectively tested whether an intervention targeting AS (i.e. an AS-augmented smoking cessation program) would predict lower suicidality in a population known to be at increased risk for death by suicide (i.e. cigarette smokers). Participants (N = 169) were randomly assigned to a standard cognitive behavioral smoking intervention or a cognitive behavioral smoking intervention with an AS reduction component. Findings indicate that the participants who received the AS-augmented intervention had lower suicidality compared to those in the standard intervention, even accounting for baseline suicidality, substance use disorder diagnosis, current depression, current anxiety, and current smoking status. As the first examination of the effect of an AS reduction program on suicidality, this study provides initial support for the hypothesis that reducing AS may lead to lower suicidality. Future work should include testing an AS intervention in a sample with elevated suicidality, as well as specifically targeting AS cognitive concerns, which has a stronger and more consistent relationship with suicidality than global AS.

Aberrant histone deacetylase2-mediated histone modifications and synaptic plasticity in the amygdala predisposes to anxiety and alcoholism

BACKGROUND

Epigenetic mechanisms have been implicated in psychiatric disorders, including alcohol dependence. However, the epigenetic basis and role of specific histone deacetylase (HDAC) isoforms in the genetic predisposition to anxiety and alcoholism is unknown.

METHODS

We measured amygdaloid HDAC activity, levels of HDAC isoforms, and histone H3 acetylation in selectively bred alcohol-preferring (P) and -nonpreferring (NP) rats. We employed HDAC2 small interfering RNA infusion into the central nucleus of amygdala (CeA) of P rats to determine the causal role of HDAC2 in anxiety-like and alcohol-drinking behaviors. Chromatin immunoprecipitation analysis was performed to examine the histone acetylation status of brain-derived neurotrophic factor (Bdnf) and activity-regulated cytoskeleton associated protein (Arc) genes. Golgi-Cox staining was performed to measure dendritic spine density.

RESULTS

We found that P rats innately display higher nuclear HDAC activity and HDAC2 but not HDAC 1, 3, 4, 5, and 6 protein levels and lower acetylation of H3-K9 but not H3-K14, in the CeA and medial nucleus of amygdala compared with NP rats. Acute ethanol exposure decreased amygdaloid HDAC activity and HDAC2 protein levels, increased global and gene (Bdnf and Arc)-specific histone acetylation, and attenuated anxiety-like behaviors in P rats but had no effects in NP rats. The HDAC2 knockdown in the CeA attenuated anxiety-like behaviors and voluntary alcohol but not sucrose consumption in P rats and increased histone acetylation of Bdnf and Arc with a resultant increase in protein levels that correlated with increased dendritic spine density.

CONCLUSIONS

These novel data demonstrate the role of HDAC2-mediated epigenetic mechanisms in anxiety and alcoholism.

A cross-cultural replication of an interactive model of anxiety sensitivity relevant to suicide

Recent findings indicate a relationship between anxiety sensitivity (AS) and suicide in a variety of populations in the United States. However, the link between AS and suicide has not been evaluated in other cultures. Suicide rates in Russia are among the highest worldwide making it an excellent choice to evaluate the cross-cultural robustness of these findings. The current investigation sought to replicate and extend the investigation of AS subfactors (i.e., cognitive, physical, and their interaction) in relation to suicidality in a sample of Russian adults. Participants were 390 adults recruited from Moscow using a geographic sampling method. Findings from the current study indicate that the interaction of AS cognitive concerns and AS physical concerns are associated with elevated rates of suicidality and previous suicide attempt, above and beyond negative affectivity and hazardous alcohol use. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns and low AS physical concerns.

Parent-child conflict and suicide rumination in college students: the mediating roles of depressive symptoms and anxiety sensitivity

OBJECTIVE

Parent-child conflict, depressive symptoms, and anxiety sensitivity have each been identified as risk factors for suicide ideation in college students. This study examined the relations among these risk factors and suicide rumination utilizing transition theory to guide the hypothesized relations.

PARTICIPANTS

Undergraduate college students participated in this study in the spring of 2012 (January to May).

METHODS

Participants completed self-report measures of parent-child conflict, depressive symptoms, anxiety sensitivity, and suicide rumination, among other measures. Hypothesized pathways and mediation were tested using path analysis.

RESULTS

Suicide rumination was positively and uniquely predicted by depressive symptoms, anxiety sensitivity, and parent-child conflict. The relation between parent-child conflict and suicide rumination was, in part, accounted for by depressive symptoms and anxiety sensitivity.

CONCLUSIONS

Results suggest that it would be advisable for clinicians to assess for students' conflicts with their parents in conjunction with their levels of depression and anxiety when assessing for suicide risk.

Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: a comparison of three models

Emerging work has identified several related constructs that appear to be relevant to anxiety psychopathology including anxiety sensitivity (AS), distress tolerance (DT) and discomfort intolerance (DI). AS refers to the fear of the consequences of anxiety-related sensations. DT measures tolerance of negative emotions, whereas DI measures tolerance of uncomfortable physical sensations. Questions, however, have been raised regarding the overlap among AS, DT, and DI. The present study conducted confirmatory factor analyses to test three models of emotional and physical tolerance to determine which model provided the best fit for the associations among AS, DT, and DI. Nonclinical individuals (N = 411) and individuals with anxiety psychopathology (N = 253) completed self-report questionnaires. Results supported a hierarchical factor structure with 2 higher order factors with AS as a lower order factor of DT. The implications of these findings for the conceptualization of the relationships among AS, DT, and DI are discussed.

Risk of co-occuring psychopathology: testing a prediction of expectancy theory

Despite the high impact of anxiety sensitivity (AS; a fear of anxiety related sensations) research, almost no research attention has been paid to its parent theory, Reiss' expectancy theory (ET). ET has gone largely unexamined to this point, including the prediction that AS is a better predictor of number of fears than current anxiety. To test Reiss' prediction, we used a large (N = 317) clinical sample of anxiety outpatients. Specifically, we examined whether elevated AS predicted number of comorbid anxiety and non-anxiety disorder diagnoses in this sample. Consistent with ET, findings indicated that AS predicted number of comorbid anxiety disorder diagnoses above and beyond current anxiety symptoms. Also, AS did not predict the number of comorbid non-anxiety diagnoses when current anxiety symptoms were accounted for. These findings represent an important examination of a prediction of Reiss' ET and are consistent with the idea that AS may be a useful transdiagnostic treatment target.

Personality mediators of psychopathy and substance dependence in male offenders

Psychopathy and substance dependence (SUD) is highly prevalent in incarcerated populations and tends to co-occur in the same individuals. The factors underlying this relationship are not clearly understood. The primary purpose of this study was to investigate whether two personality models mediate the relationship between psychopathy and substance misuse in male offenders. Ninety-two inmates in provincial correctional centers in New Brunswick completed questionnaires, including the Sensitivity to Reward Sensitivity to Punishment Questionnaire to measure behavioral activation and behavioral inhibition, the Substance Use Risk Profile Scale to measure anxiety sensitivity, introversion/hopelessness, sensation seeking and impulsivity, and the Psychopathic Personality Inventory-Revised to assess psychopathy levels. Results revealed that high impulsivity indirectly mediated the relationship between psychopathy and stimulant dependence. In addition, low anxiety sensitivity indirectly mediated the relationship between psychopathy and opioid dependence. Finally, impulsivity indirectly and inconsistently mediated the relationship between psychopathy and alcohol dependence. These results suggest that individuals with psychopathic traits are at increased risk of misusing certain drugs due to underlying personality-based differences.

Rash impulsiveness and reward sensitivity in relation to risky drinking by university students: potential roles of frontal systems

BACKGROUND

Two forms of impulsivity, rash impulsiveness and reward sensitivity, have been proposed to reflect aspects of frontal lobe functioning and promote substance use. The present study examined these two forms of impulsivity as well as frontal lobe symptoms in relation to risky drinking by university students.

METHODS

University undergraduates aged 18-26years completed the Alcohol Use Disorders Identification Test (AUDIT), Barratt Impulsiveness Scale (BIS-11), Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), Frontal Systems Behavior Scale (FrSBe), and a demographics questionnaire assessing age, gender, and age of onset of weekly drinking (AOD).

RESULTS

AUDIT-defined harmful drinkers reported earlier AOD and scored higher on BIS-11, the Sensitivity to Reward (SR) scale of the SPSRQ, and the Disinhibition and Executive Dysfunction scales of the FrSBe compared to lower risk groups. Differences remained significant after controlling for duration of alcohol exposure. Path analyses indicated that the influence of SR on AUDIT was mediated by FrSBe Disinhibition, whereas the influence of BIS-11 on AUDIT was mediated by both Disinhibition and Executive Dysfunction scales of the FrSBe.

CONCLUSIONS

Findings tentatively suggest that the influence of rash impulsiveness on drinking may reflect dysfunction in dorsolateral prefrontal and orbitofrontal systems, whereas the influence of reward sensitivity on drinking may primarily reflect orbitofrontal dysfunction. Irrespective of the underlying functional brain systems involved, results appear to be more consistent with a pre-drinking trait interpretation than effects of alcohol exposure.

Neurochemical heterogeneity of rats predicted by different measures to be high ethanol consumers

BACKGROUND

Alcoholism is a heterogeneous disease, with subjects possibly differing both in the best measure that predicts their excess consumption and in their most effective pharmacotherapy. Two different measures, high novelty-induced activity and high-fat-induced triglycerides (TGs), are known to identify subgroups of animals prone to consuming higher amounts of ethanol (EtOH). The question investigated here is whether these subgroups are, in fact, similar in their neurochemical phenotype that may contribute to their overconsumption.

METHODS

EtOH-naïve, Sprague-Dawley rats were subgrouped based on the 2 predictor measures of activity or TG levels, and then quantitative real-time polymerase chain reaction and digoxigenin-labeled in situ hybridization were used to measure their expression of hypothalamic peptides that affect EtOH intake. In additional subgroups subsequently trained to drink 9% EtOH, the opioid antagonist and alcoholism medication, naltrexone, was tested at a low dose (0.02 mg/kg, s.c.) to determine the rats' sensitivity to its effects.

RESULTS

The 2 measures, while both effective in predicting amount of EtOH intake, were found to identify distinctive subgroups. Rats with high compared to low activity exhibited significantly greater expression of galanin and enkephalin in the paraventricular nucleus (PVN) and of orexin in the perifornical lateral hypothalamus (PFLH), but no difference in melanin-concentrating hormone in PFLH or neuropeptide Y in arcuate nucleus. This contrasts with rats having high TG, which exhibited greater expression only of PVN galanin, along with reduced PFLH orexin. The high-activity rats with elevated enkephalin, but not high-TG rats, were also unusually sensitive to naltrexone, which significantly reduced their alcohol intake.

CONCLUSIONS

In addition to revealing differences in endogenous peptides and drug responsiveness in predicted high EtOH drinkers, this study demonstrates that these disturbances differ markedly between the 2 at-risk subgroups. This indicates that simple tests may be effective in identifying subjects most responsive to a specific pharmacotherapy.

Suicidality and anxiety sensitivity in adults with HIV

Suicide rates among HIV-positive individuals are more than three times higher than in the general population. Anxiety sensitivity (AS) may be clinically relevant to increasing our understanding of suicide among individuals with HIV. Specifically, relations between AS cognitive concerns and suicide related outcomes have been observed across a range of populations. The current investigation sought to examine the effect of AS and individual AS subfactors (i.e., cognitive, physical, and social concerns) in relation to suicidality in a sample of adults with HIV. Participants were 164 adults with HIV (17.1% women; mean age=48.40) recruited from AIDS service organizations in Vermont/New Hampshire and New York City. Findings from the current study indicate that AS cognitive concerns (β=0.46, p=0.001), but not the global AS factor, are positively associated with elevated rates of suicidality among persons with HIV above and beyond demographics, HIV relevant factors, and negative affectivity. There was also a negative trend for AS physical concerns in terms of suicidality (β=-0.25, p=0.07). Clinicians may benefit from implementing AS reduction strategies with HIV-positive persons who endorse elevated suicide risk as well as elevated AS cognitive concerns. The current study is limited by a cross-sectional design and lack of suicide attempt history. Future work would benefit from longitudinal examination of the observed relations, further inquiry regarding the relation between AS physical concerns and suicidality and a more comprehensive assessment of suicidality.

Anxiety sensitivity cognitive concerns predict suicidality among smokers

BACKGROUND

Anxiety along with anxiety-related risk factors is receiving increased attention in regard to its role in elevated suicidality. One such risk factor, anxiety sensitivity (AS), refers to a fear of anxiety-related symptoms. Emerging research indicates that components of AS, particularly the AS subfactor focused on cognitive arousal concerns, are significantly associated with elevated suicidality in samples of diverse clinical outpatients, clinical outpatients with PTSD symptoms, and Air Force cadets undergoing a stressful life experience. Cigarette smokers represent another relevant population for this line of research due to recent reports indicating that cigarette smoking and nicotine dependence may be related to elevated suicidality.

METHODS

Study 1 examined the role of AS and the AS subfactors in a large sample (n=343) of community adult smokers. Study 2 examined the role of AS and AS subfactors in a sample of "pack-a-day" adult smokers (n=78) who were seeking outpatient treatment for substance abuse issues.

RESULTS

Study 1 results were consistent with our a priori hypothesis that AS cognitive concerns would be significantly associated with suicidality. Additionally, after covarying for relevant substance use variables, Study 2 results were also consistent with our hypothesis that AS cognitive concerns were significantly associated with suicidality.

LIMITATIONS

Limitations included the use of suicide related outcomes, not death by suicide, and cross-sectional design.

CONCLUSIONS

These findings suggest that suicide potential in cigarette smokers may be related to AS cognitive concerns and add to the emerging literature suggesting AS cognitive concerns are a risk factor for suicidality.

The relationship among young adult college students' depression, anxiety, stress, demographics, life satisfaction, and coping styles

Recent research indicates that young adult college students experience increased levels of depression, anxiety, and stress. It is less clear what strategies college health care providers might use to assist students in decreasing these mental health concerns. In this paper, we examine the relative importance of coping style, life satisfaction, and selected demographics in predicting undergraduates' depression, anxiety, and stress. A total of 508 full-time undergraduate students aged 18-24 years completed the study measures and a short demographics information questionnaire. Coping strategies and life satisfaction were assessed using the Brief COPE Inventory and an adapted version of the Brief Students' Multidimensional Life Satisfaction Scale. Depression, anxiety, and stress were measured using the Depression Anxiety and Stress Scale-21 (DASS-21). Multiple regression analyses were used to examine the relative influence of each of the independent variables on depression, anxiety, and stress. Maladaptive coping was the main predictor of depression, anxiety, and stress. Adaptive coping was not a significant predictor of any of the three outcome variables. Reducing maladaptive coping behaviors may have the most positive impact on reducing depression, anxiety, and stress in this population.

Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history

BACKGROUND

Anxiety along with anxiety-related risk factors has been increasingly implicated in suicidal ideation and suicide attempts. One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related sensations. Subfactors of AS, notably physical and cognitive concerns, seem to be relevant to acquired capability, a risk factor for death by suicide from Joiner's (2005) Interpersonal-Psychological Theory of Suicide.

METHODS

This study examined the effect of Anxiety Sensitivity Index (ASI) total score and subfactor scores on suicidal ideation and suicide attempt history in a very large, moderately severe outpatient sample (N = 1,378).

RESULTS

Analyses were consistent with our a priori predictions about ASI cognitive concern and suicidal ideation. In contrast, ASI physical concerns did not predict previous suicide attempt as well as ASI cognitive or social concerns. However, ASI physical concerns did moderate the relationship between ASI social concerns and previous suicide attempt.

CONCLUSIONS

These findings suggest that suicide potential may be related to cognitive risk factors for anxiety.

Exercise as an adjunct treatment for opiate agonist treatment: review of the current research and implementation strategies

Opiate dependence is a significant public health concern linked to poor quality of life, comorbid psychiatric disorders, and high costs to society. Current opiate agonist treatments are an effective but limited intervention. Adjunctive interventions could improve and augment opiate agonist treatment outcomes, including drug abstinence, quality of life, and physical health. This article reviews exercise as an adjunctive intervention for opiate agonist treatment, especially in regards to improving mood and overall quality of life, while reducing other substance use. Poor adherence and dropout frequently prevent many individuals from garnering the many physical and mental health benefits of exercise. Strategies for implementing an exercise intervention, including safety considerations, are discussed.

Stress and the HPA axis: role of glucocorticoids in alcohol dependence

Stress has long been suggested to be an important correlate of uncontrolled drinking and relapse. An important hormonal response system to stress-the hypothalamic-pituitary-adrenal (HPA) axis-may be involved in this process, particularly stress hormones known as glucocorticoids and primarily cortisol. The actions of this hormone system normally are tightly regulated to ensure that the body can respond quickly to stressful events and return to a normal state just as rapidly. The main determinants of HPA axis activity are genetic background, early-life environment, and current life stress. Alterations in HPA axis regulation are associated with problematic alcohol use and dependence; however, the nature of this dysregulation appears to vary with respect to stage of alcohol dependence. Much of this research has focused specifically on the role of cortisol in the risk for, development of, and relapse to chronic alcohol use. These studies found that cortisol can interact with the brain's reward system, which may contribute to alcohol's reinforcing effects. Cortisol also can influence a person's cognitive processes, promoting habit-based learning, which may contribute to habit formation and risk of relapse. Finally, cortisol levels during abstinence may be useful clinical indicators of relapse vulnerability in alcohol-dependent people.

The effect of anxiety sensitivity on alcohol consumption among individuals with comorbid alcohol dependence and posttraumatic stress disorder

Existing research has shown that anxiety sensitivity (AS) is positively associated with alcohol use, and that individuals with high AS use alcohol to avoid or escape negative affect associated with aversive stimuli. The current study investigated the associations between AS and drinking behavior among individuals with comorbid alcohol dependence and posttraumatic stress disorder (PTSD). We assessed baseline PTSD symptoms, AS, and drinking behavior among 151 participants enrolled in a randomized clinical trial for alcohol dependence. We hypothesized that AS would moderate the association between PTSD symptoms and drinking behavior, with PTSD symptoms being more strongly associated with drinking behavior among individuals with high AS. Results showed that AS was strongly associated with PTSD (r = .48) and moderately associated with drinking behavior (r = .18). As predicted, the interaction of AS with severity of PTSD symptoms was associated with frequency of drinking; however, contrary to our hypothesis, PTSD symptoms were more strongly associated with drinking behavior among individuals with relatively low AS. The implication of the present results for treatment of both PTSD and alcohol dependence are discussed.

Relationships between state and trait anxiety inventory and alcohol use disorder identification test scores among Korean twins and families: the healthy twin study

We explored heritabilities of the State and Trait Anxiety Inventory (STAI) and the Alcohol Use Disorders Identification Test (AUDIT), and associations including genetic and environmental correlations between the phenotypes among Korean twins and their families. We analyzed the data of 1,748 participants (835 men, 913 women, 656 individuals of monozygotic twins, 173 individuals of same-sexed dizygotic twins, 919 non-twin family members, age 30-79 years) from the Healthy Twin study. Heritabilities and bivariate analyses were assessed using the SOLAR package software. In the methods of generalized estimation equations, women in the 4th quartile of state and trait scores were 17% and 15%, respectively more likely to be hazardous alcohol users compared to women in the lower three quartiles (P < .05). However, there were no significant associations between these phenotypes in men. After adjusting for age and squared age, the heritability estimates were 0.26 in men and 0.34 in women for the state score; for the trait score, 0.35 in men and 0.31 in women; for the AUDIT score, 0.32 in men and 0.37 in women (P < .001). After adjusting for age and squared age, there was a significant genetic correlation between the trait score and the AUDIT score, and a significant non-genetic correlation between the state score and the AUDIT score in women, while there were no significant genetic or non-genetic correlations between these phenotypes in men. The STAI and AUDIT scores are heritable in Koreans and the relationships between these phenotypes may be inconsistent by sex.

Anxiety, Health Risk Factors, and Chronic Disease

Anxiety disorders are the most common mental health condition and frequently co-occur with a variety of health risk factors, such as physical inactivity, cigarette smoking, and alcohol consumption. As such, untreated anxiety and increased risk for engagement in these health risk habits can further increase risk for later-onset chronic disease and complications in disease management. Contemporary studies have identified unique temporal relationships between the onset of specific anxiety disorders with smoking and alcohol use disorders. Incorporating exercise with evidence-based treatments for anxiety is emerging and promising in enhancing treatments for anxiety-related conditions. Likewise, substance use treatment programs may benefit from the detection and management of anxiety. Collaborative care models for anxiety may provide the needed systems-based approach for treating anxiety more effectively in primary and specialty care medical settings. Based on a qualitative review of the literature, this article summarizes the current research on the associations between anxiety, health risk factors, and the risk for chronic diseases. The authors also offer suggestions for future research that would help in better understanding the complex relationships between the role anxiety plays in the vulnerability for and management of physical inactivity and substance use.

Personality moderates the longitudinal relationship between psychological symptoms and alcohol use in adolescents

BACKGROUND

A great deal of research has emerged on the comorbidity between alcohol misuse and psychological symptoms (e.g., depression, anxiety, and antisocial behavior or conduct disorder) in adolescence. Research has also shown that personality traits underlie vulnerability to alcohol use and psychological symptoms, but how personality moderates this association has not been comprehensively examined. The goals of this study are to clarify (i) whether early alcohol use effects the rate of change of psychological symptoms and vice versa, (ii) whether initial levels and rate of change in both domains vary according to individual differences in personality traits, and (iii) whether personality moderates the relationship between alcohol use and psychological symptoms.

METHODS

Self-reported alcohol use, depression, anxiety, and antisocial behavior were collected from 393 adolescents at four separate time points across an 18-month period. Parallel growth models were used to assess the main objectives of the study. Personality traits [anxiety sensitivity (AS), hopelessness (H), impulsivity (IMP), and sensation seeking (SS)] were included as time-invariant predictors of initial levels and rates of change of each construct.

RESULTS

The results indicated that elevated levels of depression predicted faster rates of increase in alcohol use. Personality-specific relationships were demonstrated across all models. IMP was shown to moderate the relationship between alcohol use and depression, suggesting that adolescents who showed a susceptibility to elevated levels of IMP, and heavier drinking were less likely to demonstrate a normative decline in depression. Adolescents with higher levels of AS and anxiety were more likely to show a faster rate of increase in alcohol use.

CONCLUSIONS

These results highlight the importance of examining personality traits in studying the associations between alcohol use and psychological symptoms.

Anxiety Psychopathology and Alcohol Use among Adolescents: A Critical Review of the Empirical Literature and Recommendations for Future Research

Adolescent alcohol use is a critical public health concern; accordingly, a considerable body of work exists identifying developmentally salient risk and protective factors. One area receiving increasing attention among adults is the linkage between specific constellations of anxiety psychopathology and alcohol use problems. Relatively less is known about such linkages among adolescents, despite the onset of both anxiety-type problems and alcohol use during this developmental period. The current review presents a detailed summary and analysis of the empirical literature focused on specific forms of anxiety psychopathology as they relate to alcohol use among adolescents, and provides a number of specific recommendations for future work with an emphasis on the utility of experimental psychopathology techniques for clarifying basic questions and forwarding this body of work.

Cocaine Dependence and Anxiety Sensitivity Among Patients Presenting for Residential Drug Use Treatment

Cocaine use and dependence remains an important public health concern. Thus, the identification of individual difference factors that may maintain cocaine use remains an important goal. The goal of the current study is to test whether the cognitive vulnerability of anxiety sensitivity (AS), an identified risk factor for anxiolytic use and use-related disorders, is related to cocaine dependence diagnosis (n = 168) among a sample of drug users currently enrolled in residential treatment (N = 304). Results demonstrated that AS was significantly related to cocaine dependence and remained significant after controlling for sex, age, alcohol dependence, hallucinogen dependence, major depressive disorder, panic disorder, and posttraumatic stress disorder. Taken together, these data suggest that AS may have a specific relation to cocaine dependence, calling into question the notion that AS is positively related only to drugs with anxiolytic properties.

Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers

Anxiety sensitivity, distress tolerance, and discomfort intolerance have been identified as important factors related to alcohol use motives and alcohol-related problems. Yet, these variables are highly correlated and little work has delineated whether these psychological vulnerability factors are differentially related to alcohol use motives and problems. To fill this gap in the existing literature, the present study evaluated whether anxiety sensitivity, distress tolerance, and discomfort intolerance were differentially related to high-risk alcohol use motives (i.e., coping and conformity motives) and alcohol use problems among 224 young adult, current drinkers (52.3% women; M(age)=21.18, SD=7.08). Results indicated that distress tolerance, but not anxiety sensitivity or discomfort intolerance, was significantly related to coping motives for alcohol use. Additionally, anxiety sensitivity, but not distress tolerance or discomfort intolerance, was significantly related to conformity motives for drinking. For both sets of analyses, the observed significant effects were evident above and beyond the variance accounted for by alcohol consumption level, smoking rate, negative affectivity, and non-criterion alcohol use motives. Additionally, discomfort intolerance and anxiety sensitivity each predicted alcohol use problems; effects were not attributable to negative affectivity, cigarettes smoked per day, or shared variance with distress tolerance. Findings are discussed in relation to the role of emotional sensitivity and intolerance in terms of the motivational bases for alcohol use and alcohol use problems among young adult drinkers.

The role of anxiety sensitivity and drinking motives in predicting alcohol use: a critical review

Anxiety sensitivity (AS) is a cognitive, individual difference variable that refers to the fear of arousal-related bodily sensations. Persons with high AS fear these sensations because they believe the sensations are signs of impending catastrophic events. AS has been linked to increased alcohol consumption and also risky drinking motives, including coping and conformity motives. This paper summarizes statistical modeling studies and experimental research on the functional relationships between AS and drinking motives and alcohol consumption. AS functions as a risk factor that sets the stage for negative reinforcement by alcohol use. Whether alcohol use becomes a method of coping with AS depends on multiple risk factors and motivations. We propose an integrated model to account for the observed relationships and to guide future research. In addition, we identify key methodological limitations and directions for future research.

Development of an acceptance-based coping intervention for alcohol dependence relapse prevention

Both psychological and neurobiological findings lend support to the long-standing clinical observation that negative affect is involved in the development and maintenance of alcohol dependence, and difficulty coping with negative affect is a common precipitant of relapse after treatment. Although many current approaches to relapse prevention emphasize change-based strategies for managing negative cognitions and affect, acceptance-based strategies for preventing relapse to alcohol use are intended to provide methods for coping with distress that are fundamentally different from, though in theory complementary to, approaches that emphasize control and change. This paper describes the development of Acceptance-Based Coping for Relapse Prevention (ABCRP), a new intervention for alcohol-dependent individuals who are within 6 months of having quit drinking. Results of preliminary testing indicate that the intervention is feasible with this population; and a small uncontrolled pilot study (N = 23) showed significant (P < .01) improvements in self-reported negative affect, emotional reactivity, perceived stress, positive affect, psychological well-being, and mindfulness level, as well as a trend (P = .06) toward reduction in craving severity between pre- and postintervention assessments. The authors conclude that this acceptance-based intervention seems feasible and holds promise for improving affect and reducing relapse in alcohol-dependent individuals, warranting further research.

A meta-analytic review of the association between anxiety sensitivity and pain

In recent years, anxiety sensitivity (AS) has demonstrated applicability across a wide range of conditions. An area of particular interest has been the association between AS and pain. This study aimed to provide an accounting of the magnitude of this effect across studies of both clinical and nonclinical pain. Forty-one studies (14 clinical and 27 nonclinical pain) were evaluated in this meta-analytic review and represented the study of 5,908 participants (2,093 for clinical and 3,815 for nonclinical pain studies). Results indicate that AS was strongly associated with fearful appraisals of pain, with more modest results for measures of pain tolerance/threshold and pain-related disability. Implications of these results for the treatment of chronic pain are discussed.

Predicting anxiety: the role of experiential avoidance and anxiety sensitivity

Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are harmful, is a strong psychological risk factor for development of anxiety psychopathology; however, in most studies AS explains only a portion of the variability in anxiety symptoms. Recent theoretical and research work has suggested that experiential avoidance (EA), unwillingness to endure unpleasant internal experiences (e.g., thoughts, emotions, memories), is related to anxiety disorders. The current study examined independent contributions of EA and AS in the prediction of anxiety symptoms in a sample of 42 adults with DSM-IV anxiety disorders. Participants completed measures of AS, EA, anxiety, and depression. Correlational analyses indicated associations between AS, EA, and anxiety, yet more conservative regression analyses indicated that the Physical Concerns dimension of AS predicted anxiety symptom severity independently of EA. Theoretical and treatment implications of the results are discussed.

The Substance Use Risk Profile Scale: a scale measuring traits linked to reinforcement-specific substance use profiles

The Substance Use Risk Profile Scale (SURPS) is based on a model of personality risk for substance abuse in which four personality dimensions (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) are hypothesized to differentially relate to specific patterns of substance use. The current series of studies is a preliminary exploration of the psychometric properties of the SURPS in two populations (undergraduate and high school students). In study 1, an analysis of the internal structure of two versions of the SURPS shows that the abbreviated version best reflects the 4-factor structure. Concurrent, discriminant, and incremental validity of the SURPS is supported by convergent/divergent relationships between the SURPS subscales and other theoretically relevant personality and drug use criterion measures. In Study 2, the factorial structure of the SURPS is confirmed and evidence is provided for its test-retest reliability and validity with respect to measuring personality vulnerability to reinforcement-specific substance use patterns. In Study 3, the SURPS was administered in a more youthful population to test its sensitivity in identifying younger problematic drinkers. The results from the current series of studies demonstrate support for the reliability and construct validity of the SURPS, and suggest that four personality dimensions may be linked to substance-related behavior through different reinforcement processes. This brief assessment tool may have important implications for clinicians and future research.

Contribution of early environmental stress to alcoholism vulnerability

The most problematic aspects of alcohol abuse disorder are excessive alcohol consumption and the inability to refrain from alcohol consumption during attempted abstinence. The root causes that predispose certain individuals to these problems are poorly understood but are believed to be produced by a combination of genetic and environmental factors. Early environmental trauma alters neurodevelopmental trajectories that can predispose an individual to a number of neuropsychiatric disorders, including substance abuse. Prenatal stress (PNS) is a well-established protocol that produces perturbations in nervous system development, resulting in behavioral alterations that include hyperresponsiveness to stress, novelty, and psychomotor stimulant drugs (e.g., cocaine, amphetamine). Moreover, PNS animals exhibit enduring alterations in basal and cocaine-induced changes in dopamine and glutamate transmission within limbic structures, which exhibit pathology in drug addiction and alcoholism, suggesting that these alterations may contribute to an increased propensity to self-administer large amounts of drugs of abuse or to relapse after periods of drug withdrawal. Given that cocaine and alcohol have actions on common limbic neural substrates (albeit by different mechanisms), we hypothesized that PNS would elevate the motivation for, and consumption of, alcohol. Accordingly, we have found that male C57BL/6J mice subject to PNS exhibit higher operant responding and consume more alcohol during alcohol reinforcement as adults. Alterations in glutamate and dopamine neurotransmission within the forebrain structures appear to contribute to the PNS-induced predisposition to high alcohol intake and are induced by excessive alcohol intake. Accordingly, we are exploring the interactions between neurochemical changes produced by PNS and changes induced by consumption of alcohol in adulthood to model the biological bases of high vulnerability to alcohol abuse.

Effects of physical and verbal aggression, depression, and anxiety on drinking behavior of married partners: a prospective and retrospective longitudinal examination

In an ethnically diverse sample of 195 married couples, we conducted a latent factor growth analysis to investigate the longitudinal link (4 time points over 4 1/2 years) between marital aggression (physical and verbal aggression self- and partner-reports) and individual internalizing symptoms (depression and anxiety) as they relate to trajectories of alcohol use among husbands and wives. Alcohol use was operationalized as a latent factor with self- and partner reports of problem drinking as measured by the Michigan Alcoholism Screening Test and the Alcohol Dependence Scale. Verbal aggression by husbands or wives, by itself, has no effect on their alcohol use over time. In conjunction with depression, however, verbally aggressive husbands do have elevated drinking levels. The effects of husbands' and wives' physical aggression on their own and their partners' drinking behavior were also significant. This study is one of the first to examine the change over time in alcohol use for marital partners as related to marital aggression and internalizing symptoms. Our results shed light on areas of marital functioning (aggression, internalizing, alcohol use) that have not been investigated in conjunction with each other in a longitudinal design.

Parental history of anxiety and alcohol-use disorders and alcohol expectancies as predictors of alcohol-related problems

OBJECTIVE

Research has consistently identified a family history of alcoholism as a risk factor for alcohol-related problems, and global positive expectancies have been found to moderate this association. High rates of comorbidity between alcohol use and anxiety disorders suggest that a family history of anxiety disorders may also increase risk. Further, expectations of negative reinforcement (e.g., tension reduction) have been found to moderate the influence of anxiety-related traits. The current study sought to extend previous research by examining the influence of parental history of alcoholism, anxiety disorders, and the combination, as predictors of alcohol-related problems. Expectancies of global positive changes and tension reduction were hypothesized to moderate the influence of parental history of alcoholism and anxiety, respectively.

METHOD

Direct interviews with parents assessed their history of alcoholism and anxiety for 144 offspring (ages 18-32; 53.5% male) creating four groups: those with a parental history of alcoholism (27.80%), anxiety (22.20%), both alcoholism and anxiety (33.30%), and no history of psychopathology (16.70%). Established measures assessed the offsprings'alcohol expectancies, alcohol use, and alcohol-related problems.

RESULTS

Although expected interactions between parental alcoholism and global positive expectancies and between parental anxiety and tension-reduction expectancies were not found, global positive expectancies were associated with alcohol-related problems among the group with parental history of both alcoholism and anxiety.

CONCLUSIONS

The results suggest that the relation between parental history of alcoholism and global positive expectancies observed in previous studies may be strongest among individuals with a comorbid parental history of alcohol and anxiety disorders. Incorporating expectancies into interventions targeting individuals with a comorbid parental history of alcohol and anxiety disorders may have utility.

Understanding social anxiety as a risk for alcohol use disorders: fear of scrutiny, not social interaction fears, prospectively predicts alcohol use disorders

Increasing evidence indicates that social anxiety may be a premorbid risk factor for alcohol use disorders (AUD). The aim of this study was to replicate and extend previous work examining whether social anxiety is a risk factor for AUD by evaluating both the temporal antecedence and non-spuriousness of this relationship. We also examined whether social anxiety first-order factors (social interaction anxiety, observation anxieties) served as specific predictors of AUD. A non-referred sample of 404 psychologically healthy young adults (i.e. free from current or past Axis I psychopathology) was prospectively followed over approximately two years. Social anxiety (but not depression or trait anxiety) at baseline significantly predicted subsequent AUD onset. The relationship between social anxiety and AUD remained even after controlling for relevant variables (gender, depression, trait anxiety). Further, social anxiety first-order factors differentially predicted AUD onset, such that observation anxieties (but not social interaction anxiety) were prospectively linked to AUD onset. This study provides further support that social anxiety (and fear of scrutiny specifically) appears to serve as an important and potentially specific AUD-related variable that deserves serious attention as a potential vulnerability factor.

Personality, alcohol use, and drinking motives: a comparison of independent and combined internal drinking motives groups

It is well-established that coping and enhancement drinking motives predict college student drinking and that personality traits predict drinking motives. Little is known, however, about personality and drinking patterns among individuals who drink for both enhancement and coping reasons. University students in the current study completed questionnaires assessing personality, alcohol use, and drinking motives. Past year drinkers (N=138) were categorized into one of four groups: coping, enhancement, coping + enhancement, and noninternally motivated drinkers. Drinking was lower among noninternally motivated drinkers and higher among coping motivated drinkers; coping + enhancement motivated drinkers reported drinking at levels most consistent with the coping group. Coping motivated drinkers reported higher levels of neuroticism, negative affect, and anxiety sensitivity, and lower levels of positive affect; coping + enhancement motivated drinkers were not significantly different from the other groups on personality traits. Although coping + enhancement motivated drinkers may be at risk for problem drinking, they may be difficult to identify via personality measures.

The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings

BACKGROUND

Both clinical and population-based studies show that anxiety disorders and substance misuse frequently co-occur in adults, whereas among adolescents, less examination of this association has been done. Adolescence is frequently the time of substance use initiation and its subsequent interaction with anxiety disorders has not been fully explored. It is unknown in adolescents whether anxiety is more related to alcohol abuse versus cannabis abuse. In addition, as depression has been implicated in adolescents with both anxiety and substance misuse, its role in the association should also be considered.

OBJECTIVE

To test the association between current anxiety with alcohol versus cannabis abuse disorders.

METHOD

Cross-sectional, clinician-administered, structured assessment--using the Primary Care Evaluation of Mental Disorders--to evaluate anxiety, mood and substance abuse disorders among 632 adolescents recruited from primary care settings.

RESULTS

Results show a strong association between current anxiety and alcohol [odds ratio = 3.8; 95% confidence interval (CI) 1.2-11.8], but not cannabis (odds ratio = 1.4; 95% CI 0.4-4.7) abuse.

CONCLUSION

This association in adolescents reflects the importance for increased awareness of anxiety symptoms and alcohol use patterns in primary care. The lack of association of anxiety with cannabis abuse in this group may reflect differences in cannabis' anxiolytic properties or that this young group has had less exposure thus far. Given adolescence is a time of especially rapid psychosocial, hormonal and brain development, primary care may provide an opportunity for further investigation and, potentially, early screening and intervention.

Incremental associations between facets of anxiety sensitivity and posttraumatic stress and panic symptoms among trauma-exposed adults

The present investigation examined incremental associations between anxiety sensitivity (AS) subfactors (e.g. physical, psychological, and social concerns) and posttraumatic stress and panic symptoms among trauma-exposed adults. These effects were examined above and beyond other theoretically relevant factors, including negative affectivity and number of types of trauma exposures. The 239 participants were selected from a university- and community-based sample (129 women; mean age = 23.0 years; SD = 9.6, range = 18-65), all of whom endorsed exposure to traumatic life events. The AS psychological concerns and AS physical concerns lower order factors evidenced distinct associations with posttraumatic stress symptoms and panic-relevant symptoms, respectively. Specifically, the AS psychological concerns facet was significantly incrementally predictive of posttraumatic stress-relevant avoidance symptoms. The AS physical concerns facet was significantly incrementally predictive of panic-relevant symptoms, including anxious arousal, body vigilance, and perceived control over anxiety-related events. Results are discussed in the context of the relevant theoretical literature pertaining to shared vulnerability and comorbidity between posttraumatic stress and panic.

Anxiety sensitivity as an incremental predictor of later anxiety symptoms and syndromes

Although anxiety sensitivity (AS) has been shown to predict anxiety symptoms and panic, this literature is limited in regard to evaluating AS as an incremental predictor of anxiety psychopathology relative to other established risk factors including sex and negative affect. The present report prospectively evaluated whether AS was predictive of later changes in anxiety symptoms after controlling for potential confounding factors. Consistent with hypothesis, AS was found to be a significant, incremental predictor of anxiety symptoms over time, even after controlling for sex and negative affectivity. These data provide novel evidence for the unique association between AS of the development of anxiety symptoms.

Personality-targeted interventions delay the growth of adolescent drinking and binge drinking

BACKGROUND

Personality factors are implicated in the vulnerability to adolescent alcohol misuse. This study examined whether providing personality-targeted interventions in early adolescence can delay drinking and binge drinking in high-risk youth.

METHODS

A randomised control trial was carried out with 368 adolescents recruited from years 9 and 10 (median age 14) with personality risk factors for substance misuse. Participants received either a personality-targeted intervention or no intervention. Outcome data were collected on alcohol use through self-reports at 6 and 12-month post intervention and analyses were conducted on the full intent to treat sample.

RESULTS

Multi-group analysis of a latent growth curve model showed a group difference in the growth of alcohol use between baseline and 6-months follow-up, with the control group showing a greater increase in drinking than the intervention group for this period. Interventions were particularly effective in preventing the growth of binge drinking in those students with a sensation seeking (SS) personality. SS drinkers in the intervention group were 45% and 50% less likely to binge drink at 6 (OR = .45) and 12 months (OR = .50) respectively, than SS drinkers in the control group, p = .001, phi = .49, Number Needed to Treat = 2.0.

CONCLUSIONS

Considering the robust, inverse relationship between age of onset of alcohol use and later alcohol dependence, this intervention strategy may prove effective in preventing the onset of adult alcohol use disorders, by helping high-risk youth delay the growth of their drinking to a later developmental stage.

Introduction to anxiety sensitivity: recent findings and new directions

There has been a long-standing recognition that cognitive factors may play a formative role in anxiety and its disorders (Barlow, 2002). Since the 1980s, there has been great progress made in understanding the nature of cognitive risk for anxiety psychopathology. Within this context, numerous cognitive factors have been implicated and studied as potential risk factors for various anxiety conditions. Perhaps one of the most well-known and promising of these has been anxiety sensitivity (AS; Reiss & McNally,1985). AS is the fear of anxiety-related bodily sensations, which arise from beliefs that the sensations have harmful personal consequences (McNally,2002). To illustrate, people high in AS may be frightened of harmless heart palpitations because they believe the sensations will lead to cardiac arrest,whereas people low in AS do not fear these sensations because they believe them to be harmless. High AS is theorized to enhance anxious and fearful responding to internal cues through associative learning and/or cognitive misinterpretation (McNally, 2002). Numerous studies have indicated that AS is, in fact, related to increased risk of panic attacks (e.g., Hayward, Killen, Kraemer, & Taylor, 2000; Schmidt, Lerew, & Jackson, 1997, 1999) and anxiety disorders (Schmidt, Zvolensky, & Maner, 2006). Although the vast majority of work on AS has been conducted in relation to panic psychopathology (Zvolensky, Schmidt, Bernstein, & Keough, 2006), researchers