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Saulnier KG, Koscinski B, Flynt S, Accorso C, Allan NP. Brief observable anxiety sensitivity treatment: intervention development and a pilot randomized-controlled acceptability and feasibility trial to evaluate a brief intervention for anxiety sensitivity social concerns. Cogn Behav Ther 2024; 53:190-206. [PMID: 38014462 DOI: 10.1080/16506073.2023.2288551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
Social anxiety disorder is one of the most prevalent anxiety disorders. There is a need to develop brief, virtual, single-session interventions targeting constructs associated with social anxiety, such as anxiety sensitivity social concerns (ASSC). ASSC is the maladaptive belief about consequences arising from observable symptoms of anxious arousal. This study was designed to evaluate the initial acceptability and feasibility of a brief ASSC reduction program (Brief Observable Anxiety Sensitivity Treatment [BOAST]) which included a single clinician-led intervention session followed by a two-week ecological momentary intervention (EMI), delivered via mobile app. Participants (N = 36) were adults with elevated ASSC who were randomly assigned to receive BOAST (n = 19) or a waitlist control (n = 17). The trial was prospectively registered at clinicaltrials.gov (NCT04859790). Results supported the acceptability of BOAST with mixed findings for feasibility. Feasibility metrics for the EMI component were below pre-defined thresholds; however, there was evidence that homework completion was associated with symptom reduction. Preliminary efficacy metrics indicated that participants in the BOAST condition had large reductions in ASSC and one measure of social anxiety at 1-month follow-up. This study provides preliminary support for the acceptability of BOAST and elucidates avenues for future clinical and research efforts.
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Affiliation(s)
- Kevin G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Sierra Flynt
- Psychology Department, Ohio University, Athens, OH, USA
| | | | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Finger Lakes, NY, USA
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2
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Wolitzky-Taylor K. Integrated behavioral treatments for comorbid anxiety and substance use disorders: A model for understanding integrated treatment approaches and meta-analysis to evaluate their efficacy. Drug Alcohol Depend 2023; 253:110990. [PMID: 37866006 DOI: 10.1016/j.drugalcdep.2023.110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Substance use disorders (SUD) and anxiety disorders are highly comorbid, and this comorbidity is associated with poor clinical outcomes. Emerging research in the last decade has shifted from addressing these problems separately to the development and evaluation of behavioral treatments that integrate care for anxiety disorders (or elevated symptoms of anxiety) and SUD. METHODS An extensive literature search revealed a sufficient number of studies (K=11) to conduct a meta-analysis comparing the efficacy of integrated SUD/anxiety disorder behavioral treatment to SUD treatment alone on substance use and anxiety symptom outcomes. Randomized clinical trials including those with SUD and either anxiety disorders or elevations in constructs implicated in the maintenance of anxiety disorder/SUD comorbidity were included. This study meta-analyzes the effects of these studies. RESULTS Integrated treatments outperformed SUD treatments alone on both substance use and anxiety outcomes, with small to moderate effects favoring integrated treatments. There was no significant heterogeneity across studies in the primary analyses, such that moderator analyses to identify variables that yielded differential patterns of effect sizes were not conducted. DISCUSSION Integrated treatments for SUD/anxiety disorders demonstrate an incremental but significant and clinically meaningful improvement over SUD treatment alone for SUD/anxiety disorder comorbidity. Implications for future research and clinical practice paradigm shifting are discussed.
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Wolitzky-Taylor K, Smit T, Vujanovic AA, Zvolensky MJ. Transdiagnostic Processes Linking Posttraumatic Stress Disorder Symptoms to Alcohol Use Severity. J Dual Diagn 2023; 19:97-110. [PMID: 37389859 DOI: 10.1080/15504263.2023.2225373] [Citation(s) in RCA: 1] [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] [Indexed: 07/01/2023]
Abstract
Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, California, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Smit T, Mayorga NA, Rogers AH, Woods SP, Heggeness LF, Kauffman BY, Garey L, Zvolensky MJ. Indirect Effects of Negative Mood on Opioid Misuse and Dependence via Anxiety Sensitivity Subfacets: Evidence from Adults Reporting Chronic Pain. Subst Use Misuse 2023; 58:570-577. [PMID: 36762460 PMCID: PMC10088564 DOI: 10.1080/10826084.2023.2177969] [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] [Indexed: 02/11/2023]
Abstract
Background: Opioid misuse in the context of pain management exacts a significant public health burden. Past work has established linkages between negative mood (i.e., symptoms of anxiety and depression) and opioid misuse/dependence, yet the mechanisms underlying these associations have received little scientific investigation. Anxiety sensitivity (AS), the fear of the negative consequences of internal states, may be relevant to better understanding negative mood-opioid relations among adults with chronic pain. Methods: Simultaneous indirect effects of negative mood on opioid misuse and opioid dependence via lower-order factors of AS (physical, cognitive, and social concerns) were examined cross-sectionally in the present study. The study sample consisted of 428 adults (74.1% female, Mage = 38.27 years, SD = 11.06) who self-reported current moderate to severe chronic pain and opioid use for chronic pain. Results: Results indicated that negative mood was (in part) indirectly related to opioid misuse (in part) via AS physical and cognitive concerns and was (in part) indirectly related to opioid dependence via AS cognitive concerns only. No significant indirect effects via social concerns were observed. Discussion and Conclusions: Findings suggest the importance of further exploring the role of anxiety sensitivity cognitive and physical concerns in terms of opioid misuse and dependence among adults with chronic pain.
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Affiliation(s)
- Tanya Smit
- Department of Psychology, University of Houston
| | | | | | | | | | | | - Lorra Garey
- Department of Psychology, University of Houston
- HEALTH Institute, University of Houston
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- HEALTH Institute, University of Houston
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The association between blast exposure and transdiagnostic health symptoms on systemic inflammation. Neuropsychopharmacology 2022; 47:1702-1709. [PMID: 34400776 PMCID: PMC9283337 DOI: 10.1038/s41386-021-01138-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/09/2022]
Abstract
Chronic elevation of systemic inflammation is observed in a wide range of disorders including PTSD, depression, and traumatic brain injury. Although previous work has demonstrated a link between inflammation and various diagnoses separately, few studies have examined transdiagnostic symptoms and inflammation within the same model. The objective of this study was to examine relationships between psychiatric and health variables and systemic inflammation and to determine whether mild traumatic brain injury (mTBI) and/or exposure to blast munitions moderate these relationships. Confirmatory factor analysis in a large sample (N = 357) of post-9/11 Veterans demonstrated a good fit to a four-factor model reflecting traumatic stress, affective, somatic, and metabolic latent variables. Hierarchical regression models revealed that each of the latent variables were associated with higher levels of systemic inflammation. However, the strongest relationship with inflammation emerged among those who had both war-zone blast exposures and metabolic dysregulation, even after adjusting for mental health latent variables. Exploratory analyses showed that blast exposure was associated with metabolic dysregulation in a dose-response manner, with self-reported closer blast proximity associated with the greatest metabolic dysregulation. Together, these results provide a greater understanding of the types of symptoms most strongly associated with inflammation and underscore the importance of maintaining a healthy lifestyle to reduce the impact of obesity and other metabolic symptoms on future chronic disease in younger to middle-aged Veterans.
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Manning K, Mayorga NA, Nizio P, Heggeness LF, Kauffman BY, Garey L, Zvolensky MJ. Exploring Fatigue Sensitivity in terms of Mental Health and Fatigue Severity among a Racially and Ethnically Diverse Sample with Severe Fatigue. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2022; 10:136-145. [PMID: 36339280 PMCID: PMC9629796 DOI: 10.1080/21641846.2022.2085455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 06/11/2023]
Abstract
Background Fatigue sensitivity, or the misattribution that fatigue symptoms will lead to negative personal consequences, is one individual difference factor related to adverse behavioral health consequences. Methods The current study investigated whether fatigue sensitivity was related to panic symptoms, depression, as well as fatigue severity among 166 persons of diverse racial/ethnic backgrounds with severe fatigue. Results As hypothesized, fatigue sensitivity was statistically significantly related to greater panic symptoms, general depression, and fatigue severity. These results were evident over the variance explained by age, sex, neuroticism, and somatic symptoms. Conclusions This work is the first to evaluate fatigue sensitivity in terms of behavioral health outcomes among a racial/ethnically diverse sample with severe fatigue.
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Affiliation(s)
- Kara Manning
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Pamella Nizio
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Luke F. Heggeness
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
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7
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Short NA, Evans MK, Raudales AM, Shapiro M, Weiss NH, Schmidt NB. Anxiety sensitivity and cannabis use motives among trauma-exposed young adult cannabis users. Am J Addict 2022; 31:242-250. [PMID: 35365953 PMCID: PMC9117414 DOI: 10.1111/ajad.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 01/18/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Anxiety sensitivity, or fear of anxious arousal, may be an important risk factor for problematic cannabis use. Specifically, anxiety sensitivity may motivate cannabis use to cope with distress, particularly among trauma-exposed individuals. The current study tested associations among anxiety sensitivity, its subdomains, and cannabis use motives in a sample of trauma-exposed cannabis users. We hypothesized elevated anxiety sensitivity, particularly cognitive concerns, would be associated with increased maladaptive coping use motives, after covarying for the number of traumas and cannabis use quantity. METHOD Hypotheses were tested in a cross-sectional study of trauma-exposed young adult cannabis users (N = 56) (Mage = 20.7 years, 59% women, 73% white). Participants completed self-report measures, and a clinical interview assessing cannabis use quantity. RESULTS Multiple regression analyses indicated that elevated anxiety sensitivity was associated with increased cannabis use coping motives, after covarying for the number of traumas experienced and cannabis use quantity. Specifically, higher levels of anxiety sensitivity cognitive and social concerns were associated with coping motives for cannabis use. DISCUSSION AND CONCLUSIONS Anxiety sensitivity, particularly concerns about cognitive dyscontrol and negative social evaluations of anxious arousal, may motivate cannabis use to cope with stress among trauma-exposed cannabis users. Future research should include prospective studies with diverse samples to replicate results and determine whether intervening on anxiety sensitivity could reduce maladaptive coping motives for cannabis use. SCIENTIFIC SIGNIFICANCE The current study replicates prior research indicating anxiety sensitivity, particularly cognitive concerns, is associated with maladaptive cannabis use. Expanding on prior research, findings indicated anxiety sensitivity is associated with coping motives for cannabis use among trauma-exposed cannabis users.
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Affiliation(s)
- Nicole A. Short
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mariah K. Evans
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Alexa M. Raudales
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Mary Shapiro
- Southeastern Louisiana VA Health Care System, New Orleans, LA
| | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Papini S, Jacquart J, Zaizar ED, Telch MJ, A. J. Smits J. Targeting Anxiety Sensitivity With Evidence-Based Psychoeducation: A Randomized Waitlist-Controlled Trial of a Brief Standalone Digital Intervention. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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9
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Vujanovic AA, McGrew SJ, Walton JL, Raines AM. Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity. Addict Behav 2022; 126:107177. [PMID: 34801295 DOI: 10.1016/j.addbeh.2021.107177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/17/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; Mage = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.
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Affiliation(s)
| | - Shelby J McGrew
- University of Houston, USA; Southeast Louisiana Veterans Health Care System, USA
| | - Jessica L Walton
- Southeast Louisiana Veterans Health Care System, USA; South Central Mental Illness Research, Education and Clinical Center (MIRECC), USA; Department of Psychiatry and Behavioral Sciences, Tulane University, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, USA; South Central Mental Illness Research, Education and Clinical Center (MIRECC), USA; School of Medicine, Louisiana State University, USA.
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10
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Allan NP, Volarov M, Koscinski B, Pizzonia KL, Potter K, Accorso C, Saulnier KG, Ashrafioun L, Stecker T, Suhr J, Allan DM. Lonely, anxious, and uncertain: Critical risk factors for suicidal desire during the COVID-19 pandemic. Psychiatry Res 2021; 304:114144. [PMID: 34364010 PMCID: PMC8442981 DOI: 10.1016/j.psychres.2021.114144] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022]
Abstract
Public health measures enacted early in response to the COVID-19 pandemic resulted in unprecedented physical isolation. Social isolation, or the objective experience of being alone, and loneliness, the subjective feeling of being lonely, are both implicated in suicidal ideation. Anxiety sensitivity (i.e., fear of somatic anxiety) and intolerance of uncertainty (distress due to uncertainty), may also be heightened in response to the pandemic increasing risk for suicidal ideation in response to social isolation and loneliness. The direct and interactive relations loneliness, anxiety sensitivity, and intolerance of uncertainty shared with suicidal ideation were examined using structural equation modeling across two samples. Sample 1 comprised 635 people (M age = 38.52, SD = 10.00; 49.0% female) recruited using Mechanical Turk in May 2020. Sample 2 comprised 435 people (M age = 34.92, SD = 14.98; 76.2% female) recruited from faculty, staff, and students at a midwestern university in June 2020. Loneliness and anxiety sensitivity were positively, uniquely associated with suicidal ideation across samples. Results of this study were cross-sectional and included only self-report measures. These findings highlight loneliness and anxiety sensitivity as important correlates of suicidal ideation. Modular treatments should be employed to target these mechanisms to reduce COVID-19-related suicidal ideation.
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Affiliation(s)
- Nicholas P Allan
- Department of Psychology, Ohio University, Athens, OH, United States; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States.
| | - Marija Volarov
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Brandon Koscinski
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kendra L Pizzonia
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kaley Potter
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Catherine Accorso
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Tracy Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Julie Suhr
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Darcey M Allan
- Department of Psychology, Ohio University, Athens, OH, United States
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Anxiety Sensitivity and Distress Tolerance Predict Changes in Internalizing Symptoms in Individuals Exposed to Interpersonal Trauma. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Raines AM, Ennis CR, Allan NP, McGrew SJ, Walton JL, Rogers AH, Zvolensky MJ, Schmidt NB, Laurel Franklin C. Anxiety sensitivity and substance use: Differential levels across individuals primarily using opioids, cannabis, or stimulants. Addict Behav 2021; 116:106791. [PMID: 33497865 DOI: 10.1016/j.addbeh.2020.106791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of the current study was to compare levels of anxiety sensitivity (AS) across a treatment-seeking sample of individuals primarily using opioids, stimulants, or cannabis. Consistent with the idea that individuals high in AS may be motivated to use substances with real or perceived anxiolytic properties, it was hypothesized that individuals primarily using opioids or cannabis would evidence higher levels of AS compared to individuals primarily using stimulants. METHODS The sample consisted of 110 veterans (including 29 individuals primarily using opioids, 42 primarily using cannabis, and 39 primarily using stimulants) presenting for psychological services to a Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) specialty clinic at a large southeastern Veteran Affairs (VA) hospital. RESULTS AS levels varied by group with individuals primarily using stimulants evidencing the highest levels followed by those primarily using opioids and then those primarily using cannabis. Individuals primarily using stimulants had statistically significantly higher levels of AS physical concerns compared to individuals primarily using cannabis but not those primarily using opioids. Further, individuals who primarily use opioids did not differ from those primarily using cannabis. CONCLUSIONS Taken together, these findings call into question the notion that AS may be negatively related to the use of substances that have anxiogenic properties.
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13
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Anxiety and Opioid Use Disorder: Potential Targets for Treatment and Prevention. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-020-00350-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Rogers AH, Garey L, Allan NP, Zvolensky MJ. Exploring transdiagnostic processes for chronic pain and opioid misuse among two studies of adults with chronic pain. Behav Res Ther 2020; 136:103786. [PMID: 33316580 DOI: 10.1016/j.brat.2020.103786] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 01/28/2023]
Abstract
Chronic pain is a significant public health problem associated with functional impairment, increased medical expenditures, and opioid misuse. Recent work has suggested that certain transdiagnostic psychosocial factors may be more important than pain intensity to better understand pain and opioid outcomes. Specifically, pain-related anxiety, anxiety sensitivity, emotion dysregulation, and distress tolerance have all been uniquely associated with both pain and opioid outcomes across a range of samples. Yet, no work has examined how these transdiagnostic constructs relate to pain and opioid misuse when accounting for the other constructs. Therefore, the current study employed two independent sample of adults with chronic pain to examine (1) the construct independence of each of these factors using exploratory structural equation modelling (ESEM) and (2) how each of these constructs relates to pain and opioid outcomes in latent structural models. Results from Study 1 provided empirical support for construct independence of the transdiagnostic constructs. Findings from Study 2 indicated that pain-related anxiety was most strongly related to pain intensity, interference, and pain-related negative affect, anxiety sensitivity with opioid misuse, and emotion dysregulation with all studied criterion variables. The current results highlight the importance of assessing and targeting transdiagnostic constructs among adults with pain.
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Affiliation(s)
| | - Lorra Garey
- Department of Psychology, University of Houston, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA; HEALTH Institute, University of Houston, USA.
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15
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Smit T, Rogers AH, Garey L, Allan NP, Viana AG, Zvolensky MJ. Anxiety sensitivity and pain intensity independently predict opioid misuse and dependence in chronic pain patients. Psychiatry Res 2020; 294:113523. [PMID: 33189986 DOI: 10.1016/j.psychres.2020.113523] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/17/2020] [Indexed: 01/20/2023]
Abstract
The United States (US) population consumes an estimated 68% of the world's prescribed opioids each year, and over 2 million adults in the US suffer from an opioid use disorder. Although chronic pain populations are among the highest risk segments of the general population for opioid misuse and dependence, there is little understanding of individual risk characteristics that may contribute to greater risk for these outcomes among this group. The present investigation explored the concurrent role of anxiety sensitivity and pain intensity and their interaction in relation to opioid misuse and dependence among 429 adults with chronic pain (73.9% female, Mage = 38.32 years, SD = 11.07). Results revealed that both anxiety sensitivity and pain intensity were associated with opioid misuse and dependence. There was no evidence of an interaction for either outcome. Post-hoc analyses indicated that of the lower-order anxiety sensitivity facets, physical and mental incapacitation concerns contributed to variance in opioid misuse and only mental incapacitation concerns contributed to variance in opioid dependence. Overall, the current findings suggest the importance of assessing anxiety sensitivity in screening for opioid-related problems among persons with chronic pain, as it may represent a distinct pathway to poorer opioid-related outcomes among this group.
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Affiliation(s)
- Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
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16
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Norr AM, Katz AC, Nguyen JL, Lehavot K, Schmidt NB, Reger GM. Pilot trial of a transdiagnostic computerized anxiety sensitivity intervention among VA primary care patients. Psychiatry Res 2020; 293:113394. [PMID: 32827995 PMCID: PMC7429501 DOI: 10.1016/j.psychres.2020.113394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 10/31/2022]
Abstract
People in need of mental health treatment do not access care at high rates or in a timely manner, inclusive of Veterans at Department of Veteran's Affairs (VA) medical centers. Barriers to care have been identified, and one potential solution is the use of technology-based interventions within primary care. This study evaluated the Cognitive Anxiety Sensitivity Treatment (CAST), a previously developed computerized treatment that has shown efficacy in community samples for mental health symptoms including: anxiety, depression, post-traumatic stress, and suicidal ideation. VA primary care patients with elevated anxiety sensitivity (N = 25) were recruited to participate in a mixed-method open pilot to examine acceptability, usability, and preliminary effectiveness in a VA primary care setting. Participants completed an initial visit, that included the intervention, and a one-month follow-up. Veterans found CAST to be generally acceptable, with strong usability ratings. Qualitative analyses identified areas of strength and areas for improvement for use with VA primary care Veterans. Repeated measures ANCOVAs revealed significant effects for symptoms of anxiety, depression, traumatic-stress, and suicidal ideation. CAST could potentially have a large public health impact if deployed across VA medical centers as a first-step intervention for a range of mental health presenting concerns.
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Affiliation(s)
- Aaron M. Norr
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), United States,University of Washington School of Medicine, United States,Corresponding author at: 206-277-3257, VA Puget Sound Healthcare System, 1660 S. Columbian Way, S-116, Seattle, WA 98108, United States
| | | | | | - Keren Lehavot
- University of Washington School of Medicine, United States,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, United States
| | | | - Greg M. Reger
- University of Washington School of Medicine, United States,VA Puget Sound Healthcare System, United States
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Garey L, Zvolensky MJ, Spada MM. Third wave cognitive and behavioral processes and therapies for addictive behaviors: An introduction to the Special Issue. Addict Behav 2020; 108:106465. [PMID: 32480245 DOI: 10.1016/j.addbeh.2020.106465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Third wave cognitive and behavioral therapies have garnered significant attention in the study and treatment of addiction. Such treatments employ a process-oriented, transdiagnostic approach to mitigate problematic thought and behavioral patterns and consequences associated with substance use. Although initial evidence is promising, much remains unknown regarding the impact of third wave processes on substance use behavior and treatment outcomes. Additionally, more work is needed to elucidate the potential of novel third wave treatments on substance use outcomes. If proven successful, third wave processes and therapies may hold the key to disrupt the huge financial, societal, and personal burden associated with addiction. This Special Issue highlights recent, scientifically rigorous, clinically applicable advances in current understanding of third wave cognitive and behavioral processes and therapies for substance use. Research presented in this Special Issue covers topics ranging from the role and application of mindfulness in the etiology of substance use behavior, treatment outcomes, and familial support; the potential of transdiagnostic factors as important considerations for vulnerable groups; and the development and refinement of novel technological and integrated interventions. This Special Issue is organized into three parts classified as third wave processes and substance use behavior; third wave processes in traditional substance use treatment and their malleability; and third wave treatments for substance use among special populations. It is hoped that this issue will alert readers to the significance of this work, illustrate the many domains currently being explored via process-oriented, transdiagnostic treatment, and identify promising and impactful areas for research.
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Affiliation(s)
- Lorra Garey
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, TX 77204, USA.
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, TX 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX 77030, USA; Health Institute, Houston, TX 77204, USA
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Morabito DM, Mathes BM, Schmidt NB. The Impact of Two Brief Web-Based Psychological Interventions on Functional Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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