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Fani N, Fulton T, Botzanowski B. The Neurophysiology of Interoceptive Disruptions in Trauma-Exposed Populations. Curr Top Behav Neurosci 2024. [PMID: 38678141 DOI: 10.1007/7854_2024_469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
In the aftermath of psychological trauma, many individuals experience perturbations in interoception, a term that broadly references the ability to accurately detect body signals and integrate these signals with emotional states. These interoceptive disruptions can manifest in different ways, including blunting or amplification of sensitivity to internal physiological signals. In this chapter we review extant neurophysiological research on interoception in trauma-exposed populations, with a particular focus on the effects of chronic interpersonal trauma, such as childhood maltreatment and racial discrimination. We explore research that used different types of interoceptive assays, from self-report measures to electrophysiological and neuroimaging tools to characterize the disruptions in pain perception, interoceptive acuity, and physiological responses that may arise after a traumatic event. Finally, we discuss interventions that are designed to target interoceptive mechanisms, from exposure-based therapies to mindfulness-based practices, as well as future directions in trauma interoception research.
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Affiliation(s)
- Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Travis Fulton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Boris Botzanowski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Ward LG, Bublitz M, Sokol N, Brown S, Stroud LR. Experiences of maltreatment in childhood are associated with increasing anxiety and lower body acceptance over pregnancy. J Psychosom Res 2023; 172:111414. [PMID: 37354747 PMCID: PMC10527555 DOI: 10.1016/j.jpsychores.2023.111414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Prior studies have established that childhood sexual abuse (CSA) survivors are at increased risk for anxiety during pregnancy. Less is known about the course of anxiety throughout pregnancy for CSA survivors as well as underlying mechanisms linking CSA and perinatal anxiety. We assessed change in anxiety over the course of pregnancy for CSA survivors and examined whether acceptance and awareness of pregnancy-related body changes mediated this change. METHODS 299 pregnant participants from two larger longitudinal cohort studies were grouped into CSA (n = 67), "other Maltreatment" (OM; n = 111); and "no abuse" (NA; n = 121) based on responses to the Adverse Childhood Events scale. We used a general linear mixed model with repeated measures to examine change in anxiety (Hamilton Anxiety Scale) at two time points (MEGA = 26.2 weeks and 34.9) by abuse/maltreatment group and then examined whether group differences in anxiety were mediated by body awareness/acceptance (from Maternal Fetal Attachment Scale) using structural equation modeling. RESULTS The CSA group demonstrated higher anxiety at both gestational time-points and significantly greater increase in anxiety over gestation compared to OM and NA groups (F(1, 280) p = .046). CSA and OM groups reported significantly lower body acceptance than those without abuse/maltreatment (F(2, 287) = 3.486, p = .032). A small proportion of the total effect of CSA on change in anxiety (0.5%) was attributable to body acceptance. CONCLUSION Pregnant CSA survivors experienced a greater increase in anxiety over pregnancy compared to other groups. Both abuse/maltreatment groups exhibited lower body acceptance, yet this contributed little to the association between CSA and anxiety.
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Affiliation(s)
- L G Ward
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; The Women's Medicine Collaborative, The Miriam Hospital, 146 W. River St., Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
| | - Margaret Bublitz
- The Women's Medicine Collaborative, The Miriam Hospital, 146 W. River St., Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA
| | - Natasha Sokol
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA
| | - Shaquanna Brown
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA
| | - Laura R Stroud
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
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Lewis MW, Webb CA, Kuhn M, Akman E, Jobson SA, Rosso IM. Predicting Fear Extinction in Posttraumatic Stress Disorder. Brain Sci 2023; 13:1131. [PMID: 37626488 PMCID: PMC10452660 DOI: 10.3390/brainsci13081131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.
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Affiliation(s)
- Michael W. Lewis
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Christian A. Webb
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Manuel Kuhn
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Eylül Akman
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - Sydney A. Jobson
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - Isabelle M. Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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4
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Simpson TL, Goldberg SB, Louden DK, Blakey SM, Hawn SE, Lott A, Browne KC, Lehavot K, Kaysen D. Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis. J Anxiety Disord 2021; 84:102490. [PMID: 34763220 PMCID: PMC8819868 DOI: 10.1016/j.janxdis.2021.102490] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/17/2022]
Abstract
Over the past 20 years, numerous treatments addressing comorbid Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) have been developed and tested. The current meta-analysis examined the efficacy and acceptability of the two central treatment types- trauma-focused and non-trauma-focused - compared with all comparators and with cognitive-behavioral manualized SUD treatments immediately post-treatment and at longest follow-up. Twenty-eight randomized clinical trials (N = 3247) were included. There were small to large within-group effects for all forms of active treatment (gs = 0.30-1.11). Trauma-focused but not non-trauma-focused treatments outperformed all comparators on PTSD outcomes at post-treatment. Neither trauma-focused nor non-trauma-focused treatment outperformed all comparators on SUD outcomes at post-treatment. Neither trauma- nor non-trauma-focused treatment outperformed manualized SUD treatments on PTSD outcomes at either time point. Manualized SUD treatments outperformed trauma-focused treatments on SUD outcomes at post-treatment and non-trauma-focused treatments on PTSD outcomes at follow-up. Regarding treatment retention, neither trauma-focused nor non-trauma-focused treatments significantly differed from all comparators or from manualized SUD treatments. Between-group results were largely unchanged in trim-and-fill analyses, but were not robust to fail-safe N. Few moderators were detected. Taken together, results suggest that trauma-focused, non-trauma-focused, and manualized SUD interventions are sound options for individuals with comorbid PTSD/SUD.
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Affiliation(s)
- Tracy L. Simpson
- VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, 1660 South Columbian Way, Seattle, WA 98108, USA,University of Washington, Department of Psychiatry, 1959 NE Pacific St, Seattle, WA 98195, USA,Correspondence to: Veteran Affairs Puget Sound HealthCare - Seattle Division, 1660 South Columbian Way, Seattle, WA 98108, USA. (T.L. Simpson)
| | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin - Madison, 1000 Bascom Mall, Madison, WI 53706, USA
| | - Diana K.N. Louden
- University of Washington, Health Sciences Libraries, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Shannon M. Blakey
- Durham VA Medical Center, 508 Fulton St, Durham, NC 27705, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr, Durham, NC 27705, USA
| | - Sage E. Hawn
- Boston VA Medical Center, 150S Huntington Ave, Boston, MA 02130, USA
| | - Aline Lott
- VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, 1660 South Columbian Way, Seattle, WA 98108, USA.
| | - Kendall C. Browne
- VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, 1660 South Columbian Way, Seattle, WA 98108, USA,University of Washington, Department of Psychiatry, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Keren Lehavot
- University of Washington, Department of Psychiatry, 1959 NE Pacific St, Seattle, WA 98195, USA; VA Puget Sound Seattle/Denver HSR&D COIN, 1660 South Columbian Way, Seattle, WA 98108, USA.
| | - Debra Kaysen
- Stanford University, Department of Psychiatry, 401 Quarry Road, Stanford, CA 94305, USA.
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5
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Lebeaut A, Leonard SJ, Healy N, Raines AM, Buser SJ, Vujanovic AA. Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters. Behav Modif 2021; 46:294-320. [PMID: 34008431 DOI: 10.1177/01454455211016819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters (N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood (∆R2's = .028-.042; p's < .01); AS social concerns was incrementally associated with PTSD avoidance (∆R2 = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.
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Affiliation(s)
| | | | | | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
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6
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Emotional schemas mediate the relationship between emotion regulation and symptomatology. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01560-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Edwards ER, Liu Y, Ruiz D, Brosowsky NP, Wupperman P. Maladaptive Emotional Schemas and Emotional Functioning: Evaluation of an Integrated Model Across Two Independent Samples. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2020. [DOI: 10.1007/s10942-020-00379-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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8
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Edwards ER, Wupperman P. Research on emotional schemas: A review of findings and challenges. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12171] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Emily R. Edwards
- Department of Psychology, John Jay College of Criminal Justice, New York, New York, USA,
- Department of Psychology, CUNY Graduate Center, New York, New York, USA,
| | - Peggilee Wupperman
- Department of Psychology, John Jay College of Criminal Justice, New York, New York, USA,
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Stewart J, Witte TH. Secondary Trauma and Parenting Practices in Internet Crimes against Children Task Force Investigators. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2020; 45:1080-1099. [PMID: 32837153 PMCID: PMC7274939 DOI: 10.1007/s12103-020-09530-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/29/2020] [Indexed: 06/01/2023]
Abstract
Investigating cases of child pornography requires daily exposure to sexually explicit material involving children and may have negative implications on the mental well-being of those in this line of work. This study aimed to identify whether secondary traumatic stress symptoms were associated with participants' parenting behaviors and concerns about their own children's use of the internet. Internet Crimes Against Children Task Force workers (n = 212) completed online questionnaires measuring work exposure to sexually explicit material, secondary traumatic stress symptoms, and parenting behaviors. Professionals in this field reported a wide range of secondary trauma symptoms, and their parenting behaviors were both directly and indirectly (via secondary trauma) affected by prolonged exposure to sexually explicit material involving children. Internet monitoring behaviors were more prevalent for parents of younger children, and mothers' parenting behaviors were more strongly associated with secondary trauma symptoms than were fathers. Results have implications for mental health and parenting services for professionals in this field.
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10
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Vujanovic AA, Farris SG, Bartlett BA, Lyons RC, Haller M, Colvonen PJ, Norman SB. Anxiety sensitivity in the association between posttraumatic stress and substance use disorders: A systematic review. Clin Psychol Rev 2018; 62:37-55. [PMID: 29778929 DOI: 10.1016/j.cpr.2018.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No evidence-based, "gold standard" treatments for PTSD/SUD comorbidity are currently available. Thus, it is imperative to better understand cognitive-affective mechanisms, targetable via cognitive-behavioral intervention (i.e., malleable), that may be related to both disorders in order to improve the theory and treatment of PTSD/SUD. Anxiety sensitivity is a malleable cognitive-affective factor with relevance to both PTSD and SUD. This systematic review focused on the published literature on anxiety sensitivity and trauma/PTSD and substance use/SUD from 1966 - May 1, 2018, and includes a total of 35 manuscripts. The state of the literature, limitations, and future research directions are discussed.
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Affiliation(s)
- Anka A Vujanovic
- University of Houston, Department of Psychology, Houston, TX, USA.
| | - Samantha G Farris
- The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA; The Miriam Hospital, Centers for Behavioral and Preventative Medicine, Providence, RI, USA; Butler Hospital, Behavioral Medicine and Addictions Research Unit, Providence, RI, USA; Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, NJ, USA
| | | | - Robert C Lyons
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA
| | - Moira Haller
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA
| | - Peter J Colvonen
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Sonya B Norman
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego School of Medicine, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA
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11
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Tsur N, Defrin R, Lahav Y, Solomon Z. The traumatized body: Long-term PTSD and its implications for the orientation towards bodily signals. Psychiatry Res 2018; 261:281-289. [PMID: 29329049 DOI: 10.1016/j.psychres.2017.12.083] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 11/20/2022]
Abstract
Orientation to bodily signals is defined as the way somatic sensations are attended, perceived and interpreted. Research suggests that trauma exposure, particularly the pathological reaction to trauma (i.e., PTSD), is associated with catastrophic and frightful orientation to bodily signals. However, little is known regarding the long-term ramifications of trauma exposure and PTSD for orientation to bodily signals. Less is known regarding which PTSD symptom cluster manifests in the 'somatic route' through which orientation to bodily signals is altered. The current study examined the long-term implications of trauma and PTSD trajectories on orientation to bodily signals. Fifty-nine ex-prisoners of war (ex-POWs) and 44 controls were assessed for PTSD along three time-points (18, 30 and 35 years post-war). Orientation to bodily signals (pain catastrophizing and anxiety sensitivity-physical concerns) was assessed at T3. Participants with a chronic PTSD trajectory had higher pain catastrophizing compared to participants with no PTSD. PTSD symptom severity at T2 and T3 mediated the association between captivity and orientation. Among PTSD symptom clusters, hyperarousal at two time-points and intrusion at three time-point mediated the association between captivity and orientation. These findings allude to the cardinal role of long-term PTSD in the subjective experience of the body following trauma.
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Affiliation(s)
- Noga Tsur
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.
| | - Ruth Defrin
- Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yael Lahav
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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12
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Stephenson KR, Simpson TL, Martinez ME, Kearney DJ. Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction. J Clin Psychol 2016; 73:201-217. [PMID: 27152480 DOI: 10.1002/jclp.22323] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 02/14/2016] [Accepted: 04/03/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The current study assessed associations between changes in 5 facets of mindfulness (Acting With Awareness, Observing, Describing, Non-Reactivity, and Nonjudgment) and changes in 4 posttraumatic stress disorder (PTSD) symptom clusters (Re-Experiencing, Avoidance, Emotional Numbing, and Hyperarousal symptoms) among veterans participating in mindfulness-based stress reduction (MBSR). METHOD Secondary analyses were performed with a combined data set consisting of 2 published and 2 unpublished trials of MBSR conducted at a large Veterans Affairs hospital. The combined sample included 113 veterans enrolled in MBSR who screened positive for PTSD and completed measures of mindfulness and PTSD symptoms before and after the 8-week intervention. RESULTS Increases in mindfulness were significantly associated with reduced PTSD symptoms. Increases in Acting With Awareness and Non-Reactivity were the facets of mindfulness most strongly and consistently associated with reduced PTSD symptoms. Increases in mindfulness were most strongly related to decreases in Hyperarousal and Emotional Numbing. CONCLUSIONS These results extend previous research, provide preliminary support for changes in mindfulness as a viable mechanism of treatment, and have a number of potential practical and theoretical implications.
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Affiliation(s)
- Kyle R Stephenson
- Veterans Affairs Puget Sound Healthcare System.,Willamette University Department of Psychology
| | - Tracy L Simpson
- Veterans Affairs Puget Sound Healthcare System.,University of Washington School of Medicine
| | | | - David J Kearney
- Veterans Affairs Puget Sound Healthcare System.,University of Washington School of Medicine
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13
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Sheynin J, Moustafa AA, Beck KD, Servatius RJ, Casbolt PA, Haber P, Elsayed M, Hogarth L, Myers CE. Exaggerated acquisition and resistance to extinction of avoidance behavior in treated heroin-dependent men. J Clin Psychiatry 2016; 77:386-94. [PMID: 27046310 PMCID: PMC4822714 DOI: 10.4088/jcp.14m09284] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 05/04/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Addiction is often conceptualized as a behavioral strategy for avoiding negative experiences. In rodents, opioid intake has been associated with abnormal acquisition and extinction of avoidance behavior. Here, we tested the hypothesis that these findings would generalize to human opioid-dependent subjects. METHOD Adults meeting DSM-IV criteria for heroin dependence and treated with opioid medication (n = 27) and healthy controls (n = 26) were recruited between March 2013 and October 2013 and given a computer-based task to assess avoidance behavior. For this task, subjects controlled a spaceship and could either gain points by shooting an enemy spaceship or hide in safe areas to avoid on-screen aversive events. Hiding duration during different periods of the task was used to measure avoidance behavior. RESULTS While groups did not differ on escape responding (hiding) during the aversive event, heroin-dependent men (but not women) made more avoidance responses during a warning signal that predicted the aversive event (analysis of variance, sex × group interaction, P = .007). Heroin-dependent men were also slower to extinguish the avoidance response when the aversive event no longer followed the warning signal (P = .011). This behavioral pattern resulted in reduced opportunity to obtain reward without reducing risk of punishment. Results suggest that, in male patients, differences in avoidance behavior cannot be easily explained by impaired task performance or by exaggerated motor activity. CONCLUSIONS This study provides evidence for abnormal acquisition and extinction of avoidance behavior in opioid-dependent patients. Interestingly, data suggest that abnormal avoidance is demonstrated only by male patients. Findings shed light on cognitive and behavioral manifestations of opioid addiction and may facilitate development of therapeutic approaches to help affected individuals.
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Affiliation(s)
- Jony Sheynin
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109 ,
| | - Ahmed A. Moustafa
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA,Marcs Institute for Brain and Behaviour, University of Western Sydney, Sydney, NSW, Australia,School of Social Sciences and Psychology, University of Western Sydney, Sydney, NSW, Australia
| | - Kevin D. Beck
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA,Joint Biomedical Engineering Program, New Jersey Institute of Technology and Graduate School of Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Richard J. Servatius
- Joint Biomedical Engineering Program, New Jersey Institute of Technology and Graduate School of Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA,Department of Veterans Affairs, Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Peter A. Casbolt
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, NSW, Australia
| | - Paul Haber
- Drug Health Services, Addiction Medicine, Central Clinical School, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Mahmoud Elsayed
- Drug Health Services, Addiction Medicine, Central Clinical School, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Lee Hogarth
- School of Psychology, University of New South Wales, Sydney, NSW, Australia,School of Psychology, University of Exeter, Exeter, UK
| | - Catherine E. Myers
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA,Joint Biomedical Engineering Program, New Jersey Institute of Technology and Graduate School of Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Anxiety sensitivity mediates the association between post-traumatic stress symptom severity and interoceptive threat-related smoking abstinence expectancies among World Trade Center disaster-exposed smokers. Addict Behav 2015; 51:204-10. [PMID: 26298644 DOI: 10.1016/j.addbeh.2015.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Anxiety sensitivity (fear of internal anxiety-relevant bodily sensations) is an individual difference variable that is associated with the development and maintenance of posttraumatic stress disorder (PTSD) and is also involved in the maintenance/relapse of smoking. Abstinence expectancies are crucial to smoking maintenance, yet, past work has not explored how PTSD symptom severity and anxiety sensitivity contribute to them. METHOD Participants were 122 treatment-seeking daily smokers (36.1% female; Mage=49.2, SD=9.7; cigarettes per day: M=18.3, SD=15.2) who were exposed to the World Trade Center disaster on September 11, 2001 and responded to an advertisement for a clinical smoking cessation trial. The indirect effect of anxiety sensitivity was tested in terms of the effect of PTSD symptom severity on smoking abstinence expectancies (i.e., anxiety sensitivity as a statistical mediator). RESULTS PTSD symptom severity was positively associated with interoceptive threat-related smoking abstinence expectancies: expecting harmful consequences (β=.33, p<.001) and somatic symptoms (β=.26, p=.007). PTSD symptom severity was also significantly associated with anxiety sensitivity (β=.27, p=.003). Anxiety sensitivity mediated the association between PTSD symptom severity and expectancies about the harmful consequences (β=.09, CI95%=.02-.21; ΔR(2)=.076) and somatic symptoms (β=.11, CI95%=.02-.24; ΔR(2)=.123) from smoking abstinence, with medium effect sizes (Κ(2)=.08 and .10, respectively). CONCLUSIONS These data document the role of PTSD symptoms in threat-based expectancies about smoking abstinence and suggest anxiety sensitivity may underlie the associations between PTSD symptom severity and abstinence expectancies.
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Bardeen JR, Tull MT, Stevens EN, Gratz KL. Further Investigation of the Association between Anxiety Sensitivity and Posttraumatic Stress Disorder: Examining the Influence of Emotional Avoidance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2015; 4:163-169. [PMID: 27617195 PMCID: PMC5014493 DOI: 10.1016/j.jcbs.2015.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anxiety sensitivity (AS) and the tendency to avoid emotions have both been identified as vulnerability factors for the development and maintenance of posttraumatic stress disorder (PTSD). Furthermore, both cross-sectional and prospective research have provided evidence that emotional avoidance and AS interact to predict anxiety symptoms, such that AS may only be associated with anxiety-related pathology among those who exhibit a tendency to avoid their emotions. The purpose of the present study was to determine if this moderator model extends to PTSD within a sample of substance dependent patients. Specifically, this study examined if AS is associated with PTSD only among individuals with high (vs. low) levels of negative emotional avoidance. As predicted, results of a logistic regression analysis revealed a significant interaction between negative emotional avoidance and AS in predicting PTSD status. Follow-up analyses revealed a significant positive association between AS and PTSD status for participants high in negative emotional avoidance; however, AS was not associated with PTSD for those low in negative emotional avoidance. This finding remained even when relevant covariates were included in the model. Results confirm hypotheses and are consistent with the extant anxiety-risk literature.
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Affiliation(s)
| | | | | | - Kim L. Gratz
- University of Mississippi Medical Center, Jackson, MS, USA
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16
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Lissek S, van Meurs B. Learning models of PTSD: Theoretical accounts and psychobiological evidence. Int J Psychophysiol 2014; 98:594-605. [PMID: 25462219 DOI: 10.1016/j.ijpsycho.2014.11.006] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/29/2014] [Accepted: 11/10/2014] [Indexed: 12/18/2022]
Abstract
Learning abnormalities have long been centrally implicated in posttraumatic psychopathology. Indeed, of all anxiety disorders, PTSD may be most clearly attributable to discrete, aversive learning events. In PTSD, such learning is acquired during the traumatic encounter and is expressed as both conditioned fear to stimuli associated with the event and more general over-reactivity-or failure to adapt-to intense, novel, or fear-related stimuli. The relatively straightforward link between PTSD and these basic, evolutionarily old, learning processes of conditioning, sensitization, and habituation affords models of PTSD comprised of fundamental, experimentally tractable mechanisms of learning that have been well characterized across a variety of mammalian species including humans. Though such learning mechanisms have featured prominently in explanatory models of psychological maladjustment to trauma for at least 90years, much of the empirical testing of these models has occurred only in the past two decades. The current review delineates the variety of theories forming this longstanding tradition of learning-based models of PTSD, details empirical evidence for such models, attempts an integrative account of results from this literature, and specifies limitations of, and future directions for, studies testing learning models of PTSD.
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Affiliation(s)
- Shmuel Lissek
- University of Minnesota-Twin Cities Campus, Department of Psychology, 75 East River Road, Minneapolis, MN 55455, United States.
| | - Brian van Meurs
- University of Minnesota-Twin Cities Campus, Department of Psychology, 75 East River Road, Minneapolis, MN 55455, United States
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17
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Examining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive Adults. Int J Behav Med 2014; 22:139-48. [DOI: 10.1007/s12529-014-9404-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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López-Martínez AE, Ramírez-Maestre C, Esteve R. An examination of the structural link between post-traumatic stress symptoms and chronic pain in the framework of fear-avoidance models. Eur J Pain 2014; 18:1129-38. [PMID: 24677331 DOI: 10.1002/j.1532-2149.2014.00459.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post-traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re-experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear-avoidance models. METHODS Seven hundred fourteen patients with chronic musculoskeletal pain were assessed. Of these, 149 patients were selected for the study based upon the following inclusion criteria: exposure to a traumatic event before the onset of pain (with scores equal to or higher than 8 points on the fear and hopelessness scales of the Stressful Life Event Screening Questionnaire Revised) and scores equal to or higher than 30 on the Davidson Trauma Scale. RESULTS Structural equation modelling was used to test the association between PTSD symptoms and pain outcomes (pain intensity and disability) using the mediating variables considered in the fear-avoidance models. The results show that emotional numbing and hyperarousal symptoms, but neither re-experiencing nor avoidance, affected pain outcome via anxiety sensitivity (AS), catastrophizing and fear of pain. PTSD symptoms increased the levels of AS, which predisposes to catastrophizing and, in turn, had an effect on the tendency of pain patients to respond with more fear and avoidance. CONCLUSIONS This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain and suggests that AS is a relevant variable in the relationship between both disorders.
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Affiliation(s)
- A E López-Martínez
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatment, University of Málaga, Spain
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19
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Naifeh JA, Tull MT, Gratz KL. Anxiety Sensitivity, Emotional Avoidance, and PTSD Symptom Severity Among Crack/Cocaine Dependent Patients in Residential Treatment. COGNITIVE THERAPY AND RESEARCH 2012; 36:247-257. [PMID: 22791927 PMCID: PMC3392754 DOI: 10.1007/s10608-010-9337-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
High rates of co-occurring posttraumatic stress disorder (PTSD) have been found among patients receiving treatment for substance use disorders (SUD), and there is evidence that this particular co-occurrence is associated with negative SUD treatment outcomes. Thus, there is utility in establishing the role of psychological vulnerabilities related to PTSD within SUD populations, with the goal of ultimately informing targeted interventions and improving clinical outcomes. Anxiety sensitivity (AS) and emotional avoidance (EA) may be two important factors in this regard, as both have been found to demonstrate associations with posttraumatic stress in other clinical and nonclinical populations. To expand upon this literature, the current study examined the associations between AS and EA and PTSD symptom severity in a sample of traumatic event-exposed crack/cocaine dependent patients in residential SUD treatment (n = 62), as well as the extent to which EA mediated the relation between AS and PTSD symptom severity. As hypothesized, AS and EA were associated with PTSD symptom severity above and beyond the effects of gender and non-specific anxiety symptoms. However, the hypothesis that EA would mediate the relation between AS and PTSD symptom severity was only partially supported. Implications of these findings for understanding and treating co-occurring SUD-PTSD are discussed.
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Affiliation(s)
- James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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20
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Berenz EC, Vujanovic AA, Coffey SF, Zvolensky MJ. Anxiety sensitivity and breath-holding duration in relation to PTSD symptom severity among trauma exposed adults. J Anxiety Disord 2012; 26:134-9. [PMID: 22047652 PMCID: PMC3254809 DOI: 10.1016/j.janxdis.2011.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/23/2011] [Accepted: 10/09/2011] [Indexed: 11/23/2022]
Abstract
The present investigation examined the main and interactive effects of anxiety sensitivity and behavioral distress tolerance, indexed using the breath-holding task, in relation to PTSD symptom severity among trauma-exposed adults. Participants were 88 adults (63.6% women; M(age)=22.9, SD=9.1, range=18-62), recruited from the community, who met DSM-IV-TR PTSD Criterion A for lifetime trauma exposure. Covariates included number of potentially traumatic events, nonclinical panic attack history, and participant sex. Anxiety sensitivity was significantly incrementally associated with PTSD total symptom severity, as well as Avoidance and Hyperarousal symptom severity (p's<.01). Breath-holding duration was not significantly related to PTSD symptom severity (p's>.05). However, breath-holding duration emerged as a significant moderator of the association between anxiety sensitivity and PTSD Avoidance symptom severity, such that lower breath-holding duration exacerbated the effect of heightened anxiety sensitivity with regard to PTSD Avoidance symptom severity.
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Affiliation(s)
- Erin C Berenz
- University of Vermont, Department of Psychology, 2 Colchester Ave., Burlington, VT 05405, USA.
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21
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Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain. J Behav Ther Exp Psychiatry 2011; 42:432-9. [PMID: 21570932 PMCID: PMC3152650 DOI: 10.1016/j.jbtep.2011.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 03/28/2011] [Accepted: 04/05/2011] [Indexed: 11/20/2022]
Abstract
The aim of this study was to examine independent and combined influences of alexithymia and anxiety sensitivity on chest pain and life interference in patients with non-cardiac chest pain (NCCP). Theories of NCCP posit a central role for emotion in the experience of chest pain, however, studies have not examined how alexithymia characterized by a difficulty identifying or verbalizing emotions, may influence this relationship. This study examined 231 patients (56% females, M age=50 years) with chest pain seeking cardiac evaluation, who showed no abnormalities during exercise tolerance testing. Forty percent (40%) scored at or above the moderate range of alexithymia. Whereas health care utilization was associated with elevated alexithymia among men, health care utilization was associated with elevated anxiety sensitivity among women. Hierarchical regression analyses revealed that alexithymia and anxiety sensitivity were both uniquely and independently associated with pain severity and life interference due to pain. Alexithymia-pain links were stronger for men compared to women. Secondary analyses conducted with a subsample suggest that alexithymia may be increasingly stable over time (i.e., 18-month follow-up). Findings are largely congruent with theoretical models of NCCP showing that personality and emotional factors are important in this medically unexplained syndrome.
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22
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Gillihan SJ, Farris SG, Foa EB. The effect of anxiety sensitivity on alcohol consumption among individuals with comorbid alcohol dependence and posttraumatic stress disorder. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:721-6. [PMID: 21574671 DOI: 10.1037/a0023799] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Seth J Gillihan
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA 19104, USA.
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23
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Baslet G. Psychogenic non-epileptic seizures: a model of their pathogenic mechanism. Seizure 2010; 20:1-13. [PMID: 21106406 DOI: 10.1016/j.seizure.2010.10.032] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/22/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022] Open
Abstract
Psychogenic non-epileptic seizures (PNES) consist of paroxystic events facilitated by a dysfunction in emotion processing. Models explaining the pathogenic mechanisms leading to these seizure-like episodes are limited. In this article, evidence that supports dysfunction at the level of arousal tolerance, cognitive-emotional information processing and volitional control is reviewed. A hypothetical pathophysiological mechanism is discussed based on functional neuroimaging evidence from PNES-related conditions and traits. This pathophysiological model suggests an alteration in the influence and connection of brain areas involved in emotion processing onto other brain areas responsible for sensorimotor and cognitive processes. Integrating this information, PNES are conceptualized as brief episodes facilitated by an unstable cognitive-emotional attention system. During the episodes, sensorimotor and cognitive processes are modified or not properly integrated, allowing the deployment of autonomous prewired behavioral tendencies. Finally, I elaborate on how therapeutic applications could be modified based on the proposed hypothetical model, potentially improving clinical outcomes.
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Affiliation(s)
- Gaston Baslet
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, M/C 913, Chicago, IL 60612, USA.
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24
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Marshall GN, Miles JNV, Stewart SH. Anxiety sensitivity and PTSD symptom severity are reciprocally related: evidence from a longitudinal study of physical trauma survivors. JOURNAL OF ABNORMAL PSYCHOLOGY 2010; 119:143-50. [PMID: 20141251 DOI: 10.1037/a0018009] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cross-lagged panel analysis of interview data collected from survivors of traumatic physical injury (N = 677) was used to examine the temporal relationship between anxiety sensitivity and posttraumatic stress disorder (PTSD) symptom severity. The 2 constructs were assessed at 3 time points: within days of physical injury, at 6-month follow-up, and at 12-month follow-up. Results indicated that anxiety sensitivity and PTSD symptom severity were reciprocally related such that anxiety sensitivity predicted subsequent PTSD symptom severity, and symptom severity predicted later anxiety sensitivity. Findings have both theoretical and clinical implications.
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Abstract
PURPOSE. This study explored the relationship between self-reported mental health symptoms and help-seeking behaviors of active-duty Air Force members. DESIGN AND METHODS. Mixed-methods approach reviewed 200 postdeployment surveys from active-duty members assigned to Eglin Air Force Base, Florida, USA. Chi-square analysis examined significance between self-reporting mental health problems and accessing treatment. FINDINGS. As the rate of self-reported mental health symptoms increased, active-duty members were less inclined to seek help. There were inconsistencies among gender for self-reporting and accessing services. PRACTICE IMPLICATIONS. Air Force psychiatric nurses need to be at the forefront of outreach services when treating combat-stressed troops.
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Affiliation(s)
- Rosanne Visco
- Landstuhl Regional Medical Center, Landstuhl, Germany.
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26
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McDermott MJ, Tull MT, Gratz KL, Daughters SB, Lejuez CW. The role of anxiety sensitivity and difficulties in emotion regulation in posttraumatic stress disorder among crack/cocaine dependent patients in residential substance abuse treatment. J Anxiety Disord 2009; 23:591-9. [PMID: 19233609 PMCID: PMC2698460 DOI: 10.1016/j.janxdis.2009.01.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 01/04/2009] [Accepted: 01/12/2009] [Indexed: 12/16/2022]
Abstract
Current research suggests the importance of anxiety sensitivity (AS) in the risk for posttraumatic stress disorder (PTSD), and a growing body of research has demonstrated that difficulties in emotion regulation may also play a role. This study examined the unique relationships between AS dimensions, difficulties in emotion regulation, and a probable PTSD diagnosis among a sample of inner-city crack/cocaine dependent patients in residential substance abuse treatment. Probable PTSD participants exhibited higher levels of the AS dimension of social concerns and emotion regulation difficulties. Emotion regulation difficulties reliably distinguished probable PTSD participants from non-PTSD participants above and beyond both anxiety symptom severity and the AS dimension of social concerns. Further, social concerns did not account for unique variance when difficulties in emotion regulation was entered into the model. Results provide support for the central role of difficulties in emotion regulation relative to AS dimensions in the prediction of PTSD within a crack/cocaine dependent population.
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Affiliation(s)
- Michael J. McDermott
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stacey B. Daughters
- Center for Addictions, Personality, and Emotion Research and the Department of Psychology, University of Maryland, College Park, MD, USA
| | - C. W. Lejuez
- Center for Addictions, Personality, and Emotion Research and the Department of Psychology, University of Maryland, College Park, MD, USA
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27
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Zahradnik M, Stewart SH, Marshall GN, Schell TL, Jaycox LH. Anxiety sensitivity and aspects of alexithymia are independently and uniquely associated with posttraumatic distress. J Trauma Stress 2009; 22:131-8. [PMID: 19301252 PMCID: PMC2894609 DOI: 10.1002/jts.20397] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Using a sample of adult survivors of physical trauma requiring hospitalization (N = 677), we examined the relationship of aspects of alexithymia and anxiety sensitivity to symptoms of posttraumatic distress (PTD). At the bivariate level, both aspects of alexithymia and anxiety sensitivity were positively associated with acute PTD symptomatology, but anxiety sensitivity was more strongly related to PTD symptoms. At the multivariate level, both anxiety sensitivity and aspects of alexithymia made unique and independent contributions to both total PTD symptoms and the majority of PTD symptom clusters. At the facet level, anxiety sensitivity-physical concerns and anxiety sensitivity-psychological concerns, and the alexithymic dimension of difficulty identifying feelings, were uniquely associated with acute PTD symptoms. Findings are discussed in terms of potential clinical implications.
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Affiliation(s)
- Marc Zahradnik
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Sherry H. Stewart
- Department of Psychology, Dalhousie University, Halifax, NS, Canada,Rand Corporation, Santa Monica, CA, USA,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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28
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Thorberg FA, Young RM, Sullivan KA, Lyvers M. Alexithymia and alcohol use disorders: a critical review. Addict Behav 2009; 34:237-45. [PMID: 19010601 DOI: 10.1016/j.addbeh.2008.10.016] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 09/03/2008] [Accepted: 10/15/2008] [Indexed: 01/18/2023]
Abstract
All human beings experience emotion. However a number of individuals have difficulties recognising, processing and regulating their emotions. This set of emotional "deficits' is classified as alexithymia. The prevalence rate of alexithymia in alcohol use disorders is between 45 and 67%. The objective of this paper is to review the published research on alexithymia and alcohol use, assess the methodological quality of this evidence, and draw the findings together to present a critical update on the relationship between alexithymia and alcohol use disorders. Yet, few research studies have comprehensively investigated alexithymia in alcohol use disorders, and a number of key issues still remain to be addressed in exploring the veracity of the link between alexithymia and alcohol use. For example, limited evidence exists regarding the association between alexithymia, alcohol consumption and severity of alcohol dependence. Furthermore, there is no current knowledge about the predictive utility of alexithymia in relation to more well researched and established psychological drinking constructs. Although alexithymia is often considered a risk factor for the development of alcohol use disorders, there is little evidence to support this notion. Given that alexithymia may have the potential to interfere with treatment outcomes, a better understanding of the role of alexithymia in alcohol use is needed.
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Affiliation(s)
- Fred Arne Thorberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
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29
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Rapid avoidance acquisition in Wistar–Kyoto rats. Behav Brain Res 2008; 192:191-7. [DOI: 10.1016/j.bbr.2008.04.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 04/01/2008] [Accepted: 04/09/2008] [Indexed: 12/21/2022]
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