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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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2
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Development and Initial Evaluation of the Discomfort Sensitivity Scale. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00146-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Xiong M, Chen J, Johnson W. Relative deprivation and social anxiety among Chinese migrant children: Testing a moderated mediation model of perceived control and belief in a just world. J Health Psychol 2021; 27:2581-2602. [PMID: 34865538 DOI: 10.1177/13591053211059388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To examine the relationship between relative deprivation and social anxiety, which affects mental health, and investigate the mediating role of perceived control and the moderating role of belief in a just world (BJW) in an understudied population in Asia, we surveyed 1573 rural-to-urban migrant children (48% female; Mage = 12.3, SD = 1.7) in southeast China. Relative deprivation was positively correlated with social anxiety; perceived control partially mediated this connection. Moreover, BJW moderated the indirect effect, which was stronger for male migrant children with lower levels of BJW. The limitations and practical implications of this study are discussed.
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Affiliation(s)
- Meng Xiong
- Yangtze University, China.,University of Edinburgh, UK
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4
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Smits JAJ, Zvolensky MJ, Otto MW, Piper ME, Baird SO, Kauffman BY, Lee-Furman E, Alavi N, Dutcher CD, Papini S, Rosenfield B, Rosenfield D. Enhancing panic and smoking reduction treatment with D-Cycloserine: A pilot randomized clinical trial. Drug Alcohol Depend 2020; 208:107877. [PMID: 32004998 PMCID: PMC7039743 DOI: 10.1016/j.drugalcdep.2020.107877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Abstract
In this placebo-controlled randomized clinical trial, we examined the efficacy of 250 mg d-cycloserine (DCS) for enhancing the effects of cognitive behavior therapy targeting anxiety sensitivity reduction in the context of smoking cessation treatment among adults with a history of panic attacks. We hypothesized that DCS would enhance treatment of our mechanistic targets-anxiety sensitivity and panic and related symptoms-and result in greater smoking abstinence. A total of 53 smokers were randomized to a 7-week integrated treatment and received study medication (DCS or placebo) prior to sessions 3-5; these sessions emphasized interoceptive exposure practice. Nicotine replacement therapy was initiated at session 5 (quit date). We found that DCS augmentation led to greater reductions of one (anxiety sensitivity) of two of our mechanistic targets at early but not late assessments, and that engaging that target predicted better smoking outcomes. However, there was no evidence of group (DCS vs. placebo) differences in smoking cessation success at treatment endpoint or follow-up evaluations. Hence, although we found that DCS can enhance treatment targeting a smoking maintaining factor, additional strategies appear to be needed to significantly affect smoking outcomes.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States.
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Suite 104, Houston, TX, 77204, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States
| | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, United States
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe St. #200, Madison, WI, 53711, United States
| | - Scarlett O Baird
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Suite 104, Houston, TX, 77204, United States
| | - Eunjung Lee-Furman
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Noura Alavi
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Christina D Dutcher
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Santiago Papini
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6116 N. Central Expressway, Suite 1300, Dallas, TX, 75206, United States
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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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Matheny NL, Summers BJ, Macatee RJ, Harvey AM, Okey SA, Cougle JR. A multi-method analysis of distress tolerance in body dysmorphic disorder. Body Image 2017; 23:50-60. [PMID: 28826046 DOI: 10.1016/j.bodyim.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
Distress tolerance (DT) is a transdiagnostic construct linked to multiple psychiatric disorders. We conducted three studies using different methods to investigate the relationship between DT and body dysmorphic disorder (BDD). Study 1 found a significant relationship between low DT and more severe BDD symptoms in an adult community sample (N=81). In Study 2, we found a similar relationship between lower DT and greater BDD symptoms in a student sample (N=192). Furthermore, we found a unique relationship between greater BDD symptoms and lower self-reported tolerance of anger and sadness mood induction tasks. Greater BDD symptoms were not significantly associated with lower self-reported tolerance of a fear mood induction task. In Study 3, a clinical sample of individuals with BDD (N=40) reported lower DT than a sample of healthy controls (N=36). Findings suggest that low DT is a broad vulnerability factor related to BDD.
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Affiliation(s)
- Natalie L Matheny
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Berta J Summers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Richard J Macatee
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Ashleigh M Harvey
- Department of Psychology, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Sarah A Okey
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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7
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Farris SG, Robinson JD, Zvolensky MJ, Hogan J, Rabius V, Cinciripini PM, Karam-Hage M, Blalock JA. Panic attacks and smoking cessation among cancer patients receiving smoking cessation treatment. Addict Behav 2016; 61:32-9. [PMID: 27235990 PMCID: PMC5912332 DOI: 10.1016/j.addbeh.2016.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Little is known about factors associated with smoking cessation in cancer patients. This study examined the impact of panic attacks on smoking abstinence likelihood among cancer patients receiving tobacco cessation treatment. METHOD The relationship of panic attacks to 7-day point-prevalence abstinence at mid-treatment, end of treatment, and 6-month post-end of treatment were examined among cancer patients (N=2255 patients; 50.1% female; Mage=54.9, SD=11.0) who received counseling and pharmacotherapy for smoking cessation. Panic attack history indexed by two questions from the Patient Health Questionnaire (PHQ). Point-prevalence abstinence was assessed via the Timeline Follow-Back. RESULTS Cancer patients with a history of panic attacks, (n=493, 21.9%) relative to those without, were less likely to be abstinent at mid-treatment (OR=0.79, CI95%=0.64-0.98) and end of treatment (OR=0.72, CI95%=0.58-0.89). After adjusting for significant covariates, panic attack history remained predictive of decreased abstinence likelihood at end of treatment (OR =0.78, CI95%=0.62-0.99). CONCLUSIONS Panic attacks may be related to poorer cessation outcome during smoking treatment among cancer patients, and may be usefully assessed and targeted for intervention.
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Affiliation(s)
- Samantha G Farris
- University of Houston, Department of Psychology, Houston, TX 77024, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02906, United States.
| | - Jason D Robinson
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX 77024, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Julianna Hogan
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States.
| | - Vance Rabius
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Paul M Cinciripini
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Maher Karam-Hage
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Janice A Blalock
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
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8
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Farris SG, Paulus DJ, Gonzalez A, Mahaffey BL, Bromet EJ, Luft BJ, Kotov R, Zvolensky MJ. Posttraumatic stress symptoms and body mass index among World Trade Center disaster-exposed smokers: A preliminary examination of the role of anxiety sensitivity. Psychiatry Res 2016; 241:135-40. [PMID: 27173658 DOI: 10.1016/j.psychres.2016.04.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 12/30/2022]
Abstract
Among individuals exposed to the World Trade Center (WTC) disaster on September 11, 2001, posttraumatic stress disorder (PTSD) and symptoms are both common and associated with increased cigarette smoking and body mass. However, there is little information on the specific processes underlying the relationship of PTSD symptoms with body mass. The current study is an initial exploratory test of anxiety sensitivity, the fear of internal bodily sensations, as a possible mechanism linking PTSD symptom severity and body mass index (BMI). Participants were 147 adult daily smokers (34.0% female) exposed to the WTC disaster (via rescue/recovery work or direct witness). The direct and indirect associations between PTSD symptom severity and BMI via anxiety sensitivity (total score and subscales of physical, cognitive, and social concerns) were examined. PTSD symptom severity was related to BMI indirectly via anxiety sensitivity; this effect was specific to physical concerns about the meaning of bodily sensations. Interventions focusing on anxiety sensitivity reduction (specifically addressing physical concerns about bodily sensations) may be useful in addressing elevated BMI among trauma-exposed persons.
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Affiliation(s)
- Samantha G Farris
- University of Houston, Department of Psychology, Houston, TX, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, United States.
| | - Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Adam Gonzalez
- Stony Brook University, Department of Psychiatry, Stony Brook, NY, United States
| | - Brittain L Mahaffey
- Stony Brook University, Department of Psychiatry, Stony Brook, NY, United States
| | - Evelyn J Bromet
- Stony Brook University, Department of Psychiatry, Stony Brook, NY, United States
| | - Benjamin J Luft
- Stony Brook University, Department of Medicine, Stony Brook, NY, United States
| | - Roman Kotov
- Stony Brook University, Department of Psychiatry, Stony Brook, NY, United States
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States
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9
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Garey L, Bakhshaie J, Brandt CP, Langdon KJ, Kauffman BY, Schmidt NB, Leventhal AM, Zvolensky MJ. Interplay of dysphoria and anxiety sensitivity in relation to emotion regulatory cognitions of smoking among treatment-seeking smokers. Am J Addict 2016; 25:267-74. [PMID: 27122303 DOI: 10.1111/ajad.12379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/16/2016] [Accepted: 03/27/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet there is little understanding of how AS interplays with other affective symptomatology variables that are also related to smoking, such as dysphoria. Therefore, the current cross-sectional study evaluated the interactive effects of AS and dysphoria on emotion regulatory cognitions, including smoking negative affect reduction expectancies, perceived barriers for cessation, and smoking-specific experiential avoidance. METHOD A total of 448 adult treatment-seeking daily smokers, who responded to study advertisements, were recruited to participate in a smoking cessation treatment trial (47.8% female; Mage = 37.2, SD = 13.5). The current study utilized self-report baseline data from trial participants. RESULTS After accounting for covariates, simple slope analyses revealed that AS was positively related to negative affect reduction expectancies (β = .03, p = .01), perceived barriers to cessation (β = .22, p = .002), and smoking avoidance and inflexibility (β = .07, p = .04), among smokers with lower (vs. higher) levels of dysphoria. CONCLUSIONS The current findings suggest that higher levels of dysphoria may mitigate the relation between AS and emotion regulatory cognitions of smoking. SCIENTIFIC SIGNIFICANCE The current findings highlight the unique and additive clinical relevance of AS and dysphoria regarding emotion regulatory smoking cognitions that may impede quit success. (Am J Addict 2016;25:267-274).
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, Texas
| | | | - Kirsten J Langdon
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare Center, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | | | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Adam M Leventhal
- Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, California
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas.,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas
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Vujanovic AA, Rathnayaka N, Amador CD, Schmitz JM. Distress Tolerance: Associations With Posttraumatic Stress Disorder Symptoms Among Trauma-Exposed, Cocaine-Dependent Adults. Behav Modif 2015; 40:120-43. [PMID: 26681735 DOI: 10.1177/0145445515621490] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present investigation examined associations between distress tolerance and posttraumatic stress disorder (PTSD) symptoms in a cocaine-dependent sample. Participants were comprised of 138 cocaine-dependent adults (Mage = 45.4, SD = 9.9; 81% male; 76.3% African American) who endorsed trauma exposure, defined according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) PTSD Criterion A. Participants were administered interview-based measures and completed a series of self-report questionnaires. Results indicated that distress tolerance was significantly, incrementally (negatively) associated with PTSD symptom severity, contributing 6.8% of unique variance to the model (p < .001); notably, the overall model explained 44.8% of variance in PTSD symptomatology. Distress tolerance also contributed between 2.7% and 6.8% of unique variance across each of the PTSD symptom clusters (ps < .05). Incremental effects were documented, after accounting for the variance explained by theoretically relevant covariates (i.e., gender, cocaine-use severity, depressive symptoms, trauma-exposure severity). Theoretical and clinical implications are discussed.
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Affiliation(s)
| | | | | | - Joy M Schmitz
- University of Texas Health Science Center at Houston, USA
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11
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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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12
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Kelly MM, Jensen KP, Sofuoglu M. Co-occurring tobacco use and posttraumatic stress disorder: Smoking cessation treatment implications. Am J Addict 2015; 24:695-704. [PMID: 26584242 DOI: 10.1111/ajad.12304] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/19/2015] [Accepted: 10/24/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
- Megan M. Kelly
- Edith Nourse Rogers Memorial Veterans Hospital; Bedford Massachusetts
- Department of Psychiatry; University of Massachusetts Medical School; Worcester Massachusetts
| | - Kevin P. Jensen
- VA Connecticut Healthcare System; West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System; West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
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13
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Korte KJ, Unruh AS, Oglesby ME, Schmidt NB. Safety aid use and social anxiety symptoms: The mediating role of perceived control. Psychiatry Res 2015; 228:510-5. [PMID: 26163719 DOI: 10.1016/j.psychres.2015.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 11/25/2022]
Abstract
The use of safety aids, cognitive or behavioral strategies used to reduce or cope with anxiety, has emerged as a key construct of interest in anxiety disorders due to their role in the development and maintenance of anxiety symptoms. It has been suggested that individuals with anxiety engage in safety aid use to reduce their anxiety and feel more in control of a situation; however, no studies to date have examined the association between perceived control, that is, perceived level of control over internal events in anxiety provoking situations, and the use of safety aids. The purpose of the present study was to examine the association of perceived control, the use of safety aids, and symptoms of social anxiety. It was predicted that the association between safety aid use and social anxiety symptoms would be mediated by perceived control. This prediction was examined in a large sample of 281 participants. As predicted, perceived control was a significant mediator of the association between the use of safety aids and social anxiety symptoms. This effect remained significant after running a multiple mediation model with distress tolerance added as a competing mediator. Implications for future research are discussed.
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Affiliation(s)
- Kristina J Korte
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA
| | - Amanda S Unruh
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA
| | - Mary E Oglesby
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA.
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14
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Zvolensky MJ, Farris SG, Leventhal A, Schmidt NB. Anxiety sensitivity mediates relations between emotional disorders and smoking. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:912-920. [PMID: 25222178 PMCID: PMC4244904 DOI: 10.1037/a0037450] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has documented consistent and robust relations between emotional disorders (i.e., depressive and anxiety disorders) and smoking. Yet, it is presently unclear whether anxiety sensitivity--the fear of aversive internal anxiety states--accounts for the relations between emotional disorders and various smoking processes, including nicotine dependence, perceived barriers to smoking cessation, and severity of problematic symptoms during past cessation attempts. Participants (N = 465) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco-cessation study. Baseline (pretreatment) data were utilized. Emotional disorders were assessed via clinical diagnostic interview; self-report measures were used to assess anxiety sensitivity and 3 criterion variables: nicotine dependence, barriers to smoking cessation, and severity of problematic symptoms while quitting in past attempts. Emotional disorders were predictive of higher levels of nicotine dependence, greater perceived barriers to cessation, and greater severity of problematic symptoms while attempting to quit in the past; each of these relations were accounted for by the indirect effect of anxiety sensitivity. The present findings suggest that anxiety sensitivity may be an important transdiagnostic construct in explicating the nature of the relations between emotional disorders and various smoking processes.
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Affiliation(s)
- Michael J. Zvolensky
- University of Houston, Department of Psychology
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science
| | | | - Adam Leventhal
- Department of Psychology, University of Southern California
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
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Perceived Control and Vulnerability to Anxiety Disorders: A Meta-analytic Review. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9624-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Farris SG, Zvolensky MJ, Blalock JA, Schmidt NB. Negative affect and smoking motives sequentially mediate the effect of panic attacks on tobacco-relevant processes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:230-9. [PMID: 24720260 DOI: 10.3109/00952990.2014.891038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Empirical work has documented a robust and consistent relation between panic attacks and smoking behavior. Theoretical models posit smokers with panic attacks may rely on smoking to help them manage chronically elevated negative affect due to uncomfortable bodily states, which may explain higher levels of nicotine dependence and quit problems. METHODS The current study examined the effects of panic attack history on nicotine dependence, perceived barriers for quitting, smoking inflexibility when emotionally distressed, and expired carbon monoxide among 461 treatment-seeking smokers. A multiple mediator path model was evaluated to examine the indirect effects of negative affect and negative affect reduction motives as mediators of the panic attack-smoking relations. RESULTS Panic attack history was indirectly related to greater levels of nicotine dependence (b = 0.039, CI95% = 0.008, 0.097), perceived barriers to smoking cessation (b = 0.195, CI95% = 0.043, 0.479), smoking inflexibility/avoidance when emotionally distressed (b = 0.188, CI95% = 0.041, 0.445), and higher levels of expired carbon monoxide (b = 0.071, CI95% = 0.010, 0.230) through the sequential effects of negative affect and negative affect smoking motives. CONCLUSIONS The present results provide empirical support for the sequential mediating role of negative affect and smoking motives for negative affect reduction in the relation between panic attacks and a variety of smoking variables in treatment-seeking smokers. These mediating variables are likely important processes to address in smoking cessation treatment, especially in panic-vulnerable smokers.
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Gallagher MW, Naragon-Gainey K, Brown TA. Perceived Control is a Transdiagnostic Predictor of Cognitive-Behavior Therapy Outcome for Anxiety Disorders. COGNITIVE THERAPY AND RESEARCH 2014; 38:10-22. [PMID: 24563563 PMCID: PMC3927880 DOI: 10.1007/s10608-013-9587-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Perceived control has been proposed to be a general psychological vulnerability factor that confers an elevated risk for developing anxiety disorders, but there is limited research examining perceived control during cognitive-behavioral therapies (CBT). The present study examined whether treatment resulted in improvements in perceived control, and the indirect effects of CBT on changes in symptoms of obsessive-compulsive disorder, social phobia, generalized anxiety disorder, and panic disorder via changes in perceived control. Participants (n = 606) were a large clinical sample presenting for treatment at an outpatient anxiety disorders clinic. Participants completed a series of self-report questionnaires and a structured clinical interview at an intake evaluation and at two follow-up assessments 12 and 24 months later, with the majority of participants initiating CBT between the first two assessments. Results of latent growth curve models indicated that individuals initiating CBT subsequently reported large increases in perceived control and significant indirect effects of treatment on intraindividual changes in each of the four anxiety disorders examined via intraindividual changes in perceived control. These results suggest that the promotion of more adaptive perceptions of control is associated with recovery from anxiety disorders. Furthermore, the consistent finding of indirect effects across the four anxiety disorders examined underscores the transdiagnostic importance of perceived control in predicting CBT outcomes.
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Affiliation(s)
- Matthew W Gallagher
- National Center for PTSD, VA Boston Healthcare System, & Boston University School of Medicine
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Raines AM, Oglesby ME, Unruh AS, Capron DW, Schmidt NB. Perceived control: A general psychological vulnerability factor for hoarding. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2013.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Farris SG, Vujanovic AA, Hogan J, Schmidt NB, Zvolensky MJ. Main and interactive effects of anxiety sensitivity and physical distress intolerance with regard to PTSD symptoms among trauma-exposed smokers. J Trauma Dissociation 2014; 15:254-70. [PMID: 24803147 PMCID: PMC4013526 DOI: 10.1080/15299732.2013.834862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study examined the roles of anxiety sensitivity (AS; the tendency to misinterpret physical internal sensations of harmful) and distress tolerance (the capacity to tolerate aversive stimuli) in terms of the expression of posttraumatic stress disorder (PTSD) symptoms among a sample of trauma-exposed, treatment-seeking tobacco smokers (n = 137; Mage = 37.7 years, 48.2% female). It was hypothesized that higher AS and lower physical distress tolerance would interact to predict greater PTSD avoidance and hyperarousal symptoms. Results were partially consistent with this prediction. Specifically, there was a significant interactive effect of AS by physical distress tolerance in terms of PTSD hyperarousal symptom cluster severity. The form of the interaction was in the expected direction, with the highest levels of PTSD hyperarousal symptoms reported among smokers with higher levels of AS and a lower capacity to tolerate physical distress. Findings underscore the importance of considering AS and physical distress tolerance in terms of better understanding mechanisms underlying the expression of PTSD symptoms among trauma-exposed smokers.
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Affiliation(s)
- Samantha G Farris
- a Department of Psychology , University of Houston , Houston , Texas , USA
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Brown TA, Naragon-Gainey K. Evaluation of the unique and specific contributions of dimensions of the triple vulnerability model to the prediction of DSM-IV anxiety and mood disorder constructs. Behav Ther 2013; 44:277-92. [PMID: 23611077 PMCID: PMC3635060 DOI: 10.1016/j.beth.2012.11.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 11/15/2012] [Accepted: 11/20/2012] [Indexed: 11/15/2022]
Abstract
The triple vulnerability model (Barlow, 2000, 2002) posits that three vulnerabilities contribute to the etiology of emotional disorders: (1) general biological vulnerability (i.e., dimensions of temperament such as neuroticism and extraversion); (2) general psychological vulnerability (i.e., perceived control over life stress and emotional states); (3) disorder-specific psychological vulnerability (e.g., thought-action fusion for OCD). Despite the prominence of this model, a comprehensive empirical evaluation has not yet been undertaken. The current study used structural equation modeling to test the triple vulnerability model in a large clinical sample (N=700), focusing on vulnerabilities for depression, social phobia, generalized anxiety disorder (GAD), and OCD. Specifically, we examined the incremental prediction of each level of the triple vulnerability model for each disorder, with the following putative disorder-specific psychological vulnerabilities: thought-action fusion (TAF) for OCD, the dysfunctional attitudes (DAS) for depression, and intolerance of uncertainty (IoU) for GAD. In the final model that included all three levels of vulnerabilities, neuroticism had significant direct effects on all four disorder constructs, and extraversion was inversely associated with depression and social phobia. However, perceived control was significantly associated with GAD and OCD only. Of the disorder-specific psychological vulnerabilities, TAF was significantly and specifically related to OCD. In contrast, DAS and IoU were not significant predictors of depression and GAD respectively, instead contributing to other disorders. The results are discussed in regard to structural models of the emotional disorders and the various roles of general and specific vulnerability dimensions in the onset, severity, and temporal course of psychopathology.
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Affiliation(s)
- Timothy A Brown
- Department of Psychology, Boston University, 648 Beacon Street, 6th floor, Boston, MA 02215-2013, USA.
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McHugh RK, Otto MW. Refining the measurement of distress intolerance. Behav Ther 2012; 43:641-51. [PMID: 22697451 PMCID: PMC3483633 DOI: 10.1016/j.beth.2011.12.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 10/25/2011] [Accepted: 12/11/2011] [Indexed: 10/14/2022]
Abstract
Distress intolerance is an important transdiagnostic variable that has long been implicated in the development and maintenance of psychological disorders. Self-report measurement strategies for distress intolerance (DI) have emerged from several different models of psychopathology and these measures have been applied inconsistently in the literature in the absence of a clear gold standard. The absence of a consistent assessment strategy has limited the ability to compare across studies and samples, thus hampering the advancement of this research agenda. This study evaluated the latent factor structure of existing measures of DI to examine the degree to which they are capturing the same construct. Results of confirmatory factor analysis in three samples totaling 400 participants provided support for a single-factor latent structure. Individual items of these four scales were then correlated with this factor to identify those that best capture the core construct. Results provided consistent support for 10 items that demonstrated the strongest concordance with this factor. The use of these 10 items as a unifying measure in the study of DI and future directions for the evaluation of its utility are discussed.
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Current world literature. Curr Opin Psychiatry 2011; 24:78-87. [PMID: 21116133 DOI: 10.1097/yco.0b013e3283423055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marshall-Berenz EC, Vujanovic AA, Bonn-Miller MO, Bernstein A, Zvolensky MJ. Multimethod study of distress tolerance and PTSD symptom severity in a trauma-exposed community sample. J Trauma Stress 2010; 23:623-30. [PMID: 20848616 PMCID: PMC3209507 DOI: 10.1002/jts.20568] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Despite initial evidence linking distress tolerance to posttraumatic stress disorder (PTSD) symptom severity, there is a need for the investigation of interrelations among multiple measures of distress tolerance and PTSD symptom severity. Therefore, the present study investigated concurrent relations among multiple measures of distress tolerance, as well as the relations between these measures and PTSD symptom severity, within a trauma-exposed community sample. The sample consisted of 81 trauma-exposed adults (63.1% women). Results indicated that Distress Tolerance Scale (Simons & Gaher, 2005) scores, but no other measures of distress tolerance were significantly related to PTSD symptom severity above and beyond the variance accounted for by number of traumas, trait-level neuroticism, and participant sex. Implications and future directions are discussed.
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Affiliation(s)
| | - Anka A. Vujanovic
- Staff Research Psychologist, National Center for PTSD–Behavioral Science Division, VA Boston Health Care System, and Division of Psychiatry, Boston University School of Medicine
| | - Marcel O. Bonn-Miller
- National Center for PTSD–Dissemination and Training Division and Center for Health Care Evaluation, VA Palo Alto Health Care System
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