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Stewart SH, Khoury JMB, Watt MC, Collins P, DeGrace S, Romero-Sanchiz P. Effects of sexual assault vs. other traumatic experiences on emotional and cannabis use outcomes in regular cannabis users with trauma histories: moderation by gender? Front Psychol 2024; 15:1386264. [PMID: 38882518 PMCID: PMC11178137 DOI: 10.3389/fpsyg.2024.1386264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/06/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction While sexual assault may have particularly adverse emotional effects compared with other forms of trauma, it remains unclear which emotional outcome dimensions are impacted, whether cannabis outcomes are similarly impacted, and whether gender differences exist in sexual assault's links with these outcomes. Methods N = 100 cannabis users with trauma histories (M age = 33.1) completed standardized measures of demographics, trauma exposure, posttraumatic stress (PTS) and depressive symptoms, hopelessness, and cannabis outcomes (frequency, medicinal prescription, motives, and craving). Results Sexual assault was experienced more often by women (83.9%) than men (31.8%). A series of 2 × 2 analyses of variance [gender: women (n = 56) vs. men (n = 44) × trauma type: sexual assault (n = 61) vs. other (n = 39)] and logistic regression revealed that sexual assault survivors scored higher than other trauma survivors on re-experiencing and hyperarousal PTS symptoms (DSM-5 Clusters B and E), cognitive depressive symptoms, hopelessness, cannabis use frequency, medicinal cannabis prescription, cannabis use to cope with psychological symptoms, and compulsivity craving; and lower on social and enhancement cannabis use motives. In terms of gender main effects, women scored higher than men on cannabis use to cope with negative emotions. In terms of interactions for PTS Cluster D symptoms (negative alterations in mood/cognitions), among men only, sexual assault survivors scored higher than other trauma survivors; and for cannabis enhancement motives and purposefulness cannabis craving, among sexual assault survivors only, women scored higher than men. Discussion Across many different trauma, women survivors' use of cannabis to cope with negative affect should be a specific therapeutic focus. Moreover, we identified specific emotional and cannabis use outcomes that should be of specific clinical concern among sexual assault survivors regardless of gender. Finally, in terms of gender differences of clinical interest among sexual assault survivors, while PTS Cluster D symptoms should be specific treatment targets in men, cannabis enhancement motives and purposefulness craving should be treatment targets in women.
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Affiliation(s)
- Sherry H Stewart
- Mood, Anxiety, and Addiction Comorbidity Lab, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | | | - Margo C Watt
- Department of Psychology, Saint Francis Xavier University, Antigonish, NS, Canada
| | - Pamela Collins
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sarah DeGrace
- Mood, Anxiety, and Addiction Comorbidity Lab, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Kiiroja L, Stewart SH, Gadbois S. Can scent-detection dogs detect the stress associated with trauma cue exposure in people with trauma histories? A proof-of-concept study. FRONTIERS IN ALLERGY 2024; 5:1352840. [PMID: 38606088 PMCID: PMC11006987 DOI: 10.3389/falgy.2024.1352840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/02/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is an impairing mental health condition with high prevalence among military and general populations alike. PTSD service dogs are a complementary and alternative intervention needing scientific validation. We investigated whether dogs can detect putative stress-related volatile organic compounds (VOCs) in the breath of people with trauma histories (54% with PTSD) exposed to personalized trauma cues. Methods Breath samples were collected from 26 humans over 40 experimental sessions during a calm (control breath sample) and stressed state induced by trauma cue exposure (target breath sample). Two scent detection canines were presented with the samples in a two alternative forced choice (2AFC) discrimination and yes/no detection task. The 2AFC task assessed the dogs' ability to discriminate between the two states within the breath samples of one individual. The detection task determined their ability to generalize the target odour across different individuals and different stressful events of one individual. Signal Detection Theory was applied to assess dogs' sensitivity, specificity, precision, and response bias. Results The dogs performed at ∼90% accuracy across all sample sets in the discrimination experiment, and at 74% and 81% accuracy, respectively, in the detection experiment. Further analysis of dog olfactory performance in relation to human donor self-reported emotional responses to trauma cue exposure suggested the dogs may have been detecting distinct endocrine stress markers. One dog's performance correlated with the human donors' self-reported fear responses and the other dog's performance correlated with the human donors' self-reported shame responses. Based on these correlations between dog performance and donor self-report measures, we speculate that the VOCs each dog was detecting likely originated from the sympathetico-adreno-medullary axis (SAM; adrenaline, noradrenaline) in the case of the first dog and the hypothalamo-pituitary-adrenal axis (HPA; glucocorticoids) in the case of the second dog. Conclusion Our proof-of-concept study is the first to demonstrate that some dogs can detect putative VOCs emitted by people with trauma histories when experiencing distress theoretically associated with the intrusion and arousal/reactivity symptoms of PTSD. Results have potential to improve the effectiveness and training protocol of PTSD service dogs with a focus on enhancing their alert function.
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Affiliation(s)
- Laura Kiiroja
- Canine Olfaction Lab, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Canine Olfaction Lab, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Mood, Anxiety, and Addictions Comorbidity (MAAC) Lab, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Simon Gadbois
- Canine Olfaction Lab, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Mojallal M, Simons RM, Simons JS, Swaminath S. Daily exposure to combat-related cues and posttraumatic stress symptoms among veterans: Moderating effects of peri- and postdeployment experiences. J Trauma Stress 2024; 37:57-68. [PMID: 37985123 DOI: 10.1002/jts.22991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 11/22/2023]
Abstract
One of the central symptoms of posttraumatic stress disorder (PTSD) is a heightened reactivity to trauma cues. The current study used experience sampling to investigate the associations between exposure to combat-related cues and PTSD symptoms in 93 U.S. veterans who served in support of recent military operations in Afghanistan and Iraq. We also examined the effects of peri- and postdeployment factors, including exposure to combat, unit support during deployment, and postdeployment social support on PTSD. Participants completed eight brief random surveys daily for 2 weeks using palmtop computers. The results indicated that more daytime exposure to trauma cues was associated with experiencing more PTSD symptoms at the within-person level, B = 3.18. At the between-person level, combat exposure, B = 4.20, was associated with more PTSD symptoms, whereas unit support, B = -0.89, was associated with experiencing fewer symptoms. At the cross-level interaction, unit support, B = -0.80, moderated the association between trauma cue exposure and PTSD symptom count. Contrary to our hypothesis, postdeployment social support, B = -0.59, was not associated with PTSD symptoms. These findings suggest a functional association between exposure to trauma cues and PTSD symptoms among recent-era U.S. veterans and underscore the importance of unit support during deployment.
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Affiliation(s)
- Mahsa Mojallal
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Raluca M Simons
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Surabhi Swaminath
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
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Johnstone S, Sorkhou M, Zhang M, Dermody SS, Rabin RA, George TP. Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:95-105. [PMID: 38214479 DOI: 10.1080/00952990.2023.2292010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/03/2023] [Indexed: 01/13/2024]
Abstract
CLINICAL TRIAL NAME Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in SchizophreniaURL: www.clinicaltrials.gov; Registration Number: NCT03189810.
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Affiliation(s)
- Samantha Johnstone
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Maryam Sorkhou
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Molly Zhang
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Sarah S Dermody
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Rachel A Rabin
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Tony P George
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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DeGrace S, Romero-Sanchiz P, Tibbo P, Barrett S, Arenella P, Cosman T, Atasoy P, Cousijn J, Wiers R, Keough MT, Yakovenko I, O'Connor R, Wardell J, Rudnick A, Nicholas Carleton R, Heber A, Stewart SH. Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories? Behav Res Ther 2023; 169:104387. [PMID: 37625353 DOI: 10.1016/j.brat.2023.104387] [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: 05/12/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023]
Abstract
Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.
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Affiliation(s)
- S DeGrace
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada.
| | - P Romero-Sanchiz
- School of Psychology, University of Sussex Sussex House, Falmer, Brighton, BN1 9RH, United Kingdom
| | - P Tibbo
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada
| | - S Barrett
- Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Halifax, NS, B3H 4R2, Canada
| | - P Arenella
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada
| | - T Cosman
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada
| | - P Atasoy
- Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Halifax, NS, B3H 4R2, Canada
| | - J Cousijn
- Universiteit van Amsterdam, Department of Psychology, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, Netherlands
| | - R Wiers
- Universiteit van Amsterdam, Department of Psychology, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, Netherlands
| | - M T Keough
- York University, Department of Psychology, 4700 Keele St, North York, ON, M3J 1P3, Canada
| | - I Yakovenko
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada; Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Halifax, NS, B3H 4R2, Canada
| | - R O'Connor
- Concordia University, Department of Psychology, 7141 Sherbrooke West PY-146, Montreal, QC, H4B 1R6, Canada
| | - J Wardell
- York University, Department of Psychology, 4700 Keele St, North York, ON, M3J 1P3, Canada
| | - A Rudnick
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada
| | - R Nicholas Carleton
- University of Regina, Department of Psychology, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - A Heber
- McMaster University, Department of Psychiatry and Behavioural Neurosciences, 100 West 5th Street, Hamilton, ON, Canada
| | - S H Stewart
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada; Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Halifax, NS, B3H 4R2, Canada
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DeGrace S, Romero‐Sanchiz P, Yakovenko I, Barrett SP, Tibbo P, Cosman T, Atasoy P, Stewart SH. Do we really need two sessions?: The use of a structured interview as a trauma cue reactivity paradigm. Int J Methods Psychiatr Res 2023; 33:e1979. [PMID: 37430485 PMCID: PMC10804321 DOI: 10.1002/mpr.1979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVES Derived from classical conditioning theory and rooted in motivational mechanisms, cue reactivity paradigms (CRPs) are used in addictions research to measure participants' propensities for substance-relevant responses (e.g., craving) during exposure to substance-relevant cues (e.g., drug paraphernalia). CRPs are also useful in PTSD-addiction comorbidity research, allowing the study of affective and substance-relevant responses to trauma cues. However, studies using traditional CRPs are time-consuming with high attrition rates due to repeat testing. Thus, we sought to test whether a single session semi-structured trauma interview could serve as a CRP in terms of eliciting theorized cue exposure effects on craving and affect measures. METHOD Fifty regular cannabis users with trauma histories provided detailed descriptions of their most traumatic lifetime experience, and a neutral experience, according to an established interview protocol. Linear mixed models examined the effect of cue type (trauma vs. neutral) on affective and craving responses. RESULTS As hypothesized, the trauma interview elicited significantly greater cannabis craving (and alcohol craving among the drinkers), and, greater negative affect among those with more severe PTSD symptoms, compared to the neutral interview. CONCLUSION Results suggest an established semi-structured interview may function effectively as a CRP for use in trauma and addictions research.
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Affiliation(s)
- Sarah DeGrace
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Igor Yakovenko
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Sean P. Barrett
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Philip Tibbo
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Tessa Cosman
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Pars Atasoy
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Sherry H. Stewart
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
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Regier PS, Gawrysiak MJ, Jagannathan K, Childress AR, Franklin TR, Wetherill RR. Trauma exposure among cannabis use disorder individuals was associated with a craving-correlated non-habituating amygdala response to aversive cues. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100098. [PMID: 36844163 PMCID: PMC9948813 DOI: 10.1016/j.dadr.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
The relationship of cannabis-use disorder and trauma exposure at the level of the brain is not well-understood. Cue-reactivity paradigms have largely focused on characterizing aberrant subcortical function by averaging across the entire task. However, changes across the task, including a non-habituating amygdala response (NHAR), may be a useful biomarker for relapse vulnerability and other pathology. This secondary analysis utilized existing fMRI data from a CUD population with (TR-Y, n = 18) or without trauma (TR-N, n = 15). Amygdala reactivity to novel and repeated aversive cues was examined between TR-Y vs. TR-N groups, using a repeated measures ANOVA. Analysis revealed a significant interaction between TR-Y vs. TR-N and amygdala response to novel vs. repeated cues in the amygdala (right: F (1,31) = 5.31, p = 0.028; left: F (1,31) = 7.42, p = 0.011). In the TR-Y group, a NHAR was evident, while the TR-N group exhibited amygdala habituation, resulting in a significant difference between groups of amygdala reactivity to repeated cues (right: p = 0.002; left: p < 0.001). The NHAR in the TR-Y (but not TR-N) group was significantly correlated with higher cannabis craving scores, yielding a significant group difference (z = 2.1, p = 0.018). Results suggest trauma interacts with the brain's sensitivity to aversive cues, offering a neural explanation for the relationship between trauma and CUD vulnerability. These findings suggest the importance of considering the temporal dynamics of cue reactivity and trauma history in future studies and treatment planning, as this distinction may help decrease relapse vulnerability.
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Affiliation(s)
- Paul S. Regier
- University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, United States,Corresponding author.
| | - Michael J. Gawrysiak
- University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, United States,West Chester University of Pennsylvania, 125 West Rosedale Avenue, 19383, United States
| | - Kanchana Jagannathan
- University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, United States
| | - Anna Rose Childress
- University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, United States
| | - Teresa R. Franklin
- University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, United States
| | - Reagan R. Wetherill
- University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, United States
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Vujanovic AA, Webber HE, Wardle MC, Green CE, Lane SD, Schmitz JM. Nonjudgmental acceptance: Associations with substance-related cue reactivity in adults with substance use disorders and posttraumatic stress. Addict Behav 2022; 126:107211. [PMID: 34923324 PMCID: PMC8713456 DOI: 10.1016/j.addbeh.2021.107211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/01/2022]
Abstract
The present investigation examined the predictive utility of nonjudgmental acceptance, a facet of mindfulness defined as the ability to remain aware and nonevaluative about internal experience, in terms of substance-related cue reactivity among adults with substance use disorders (SUD) and posttraumatic stress (PTS) symptomatology. We hypothesized that higher nonjudgmental acceptance, indexed via self-report, would predict higher levels of self-reported control over oneself and safety 'in the moment', broadly, and lower levels of substance-related craving in response to substance script cues. Effects were expected after subtracting reactivity to neutral script cues from each outcome rating. PTS severity was included as a covariate. The sample was comprised of 53 adults (48.1% women; 75.9% African American; 74.1% with past-month PTSD) with substance dependence per DSM-IV and at least four symptoms of PTSD per DSM-5. Higher baseline nonjudgmental acceptance predicted greater safety and control in response to substance cues; no effects were found for craving. These experimental laboratory results elucidate the potential clinical utility of mindfulness-based interventions in bolstering recovery from addiction among adults with SUD/PTS by fostering safety and control in response to substance cues.
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Affiliation(s)
- Anka A. Vujanovic
- University of Houston, 3695 Cullen Boulevard – 126 Heyne, Houston, TX 77204,Correspondence concerning this article should be addressed to Anka A. Vujanovic, Ph.D., Trauma and Stress Studies Center, Department of Psychology, University of Houston, 3695 Cullen Boulevard, 126 Heyne Building, Houston, TX 77204, USA. ; Telephone: 713-743-3241; Fax: 713-743-5855
| | - Heather E. Webber
- University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX 77054
| | - Margaret C. Wardle
- University of Illinois at Chicago, 1007 W. Harrison Street, Chicago, IL 60607
| | - Charles E. Green
- University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX 77054
| | - Scott D. Lane
- University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX 77054
| | - Joy M. Schmitz
- University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX 77054
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