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Mian MN, Chan Osilla K, Blonigen D. Cannabis Use Among U.S. Military Veterans Following Residential Substance Use Disorder Treatment. Mil Med 2023; 188:e3591-e3598. [PMID: 37294846 PMCID: PMC10629989 DOI: 10.1093/milmed/usad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/03/2023] [Accepted: 06/01/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Use rates of cannabis, a substance associated with a host of comorbid physical and mental health concerns, continue to rise for military veterans. Despite this prevalence, descriptive patterns of use among veterans and research on treatment factors that predict cannabis outcomes are lacking. This study aimed to conduct a descriptive profile of veterans who endorse cannabis use, compare veterans endorsing cannabis use to those who do not endorse use, and investigate what factors (other substance use, psychiatric symptoms, and treatment outcomes) predicted return to cannabis use following residential treatment. MATERIALS AND METHODS The study was a secondary data analysis of a longitudinal sample of U.S. military veterans (N = 200, 193 males, Mage = 50.14, SD = 9) participating in residential substance use disorder treatment through a Veterans Affairs medical center. Interview, survey, and electronic health data were collected over 12 months. Analyses included descriptive and frequency statistics to identify patterns in cannabis use behaviors and motives, independent t-tests to examine differences between the cannabis-using group and non-using group, and a series of univariate logistic regressions to examine potential predictors for cannabis use after treatment discharge. RESULTS Lifetime cannabis use was common among veterans (77.5%), and 29.5% reported use during the study. On average, veterans had made one quit attempt before treatment entry. Veterans who endorsed cannabis use consumed more alcohol in the past 30 days at baseline and reported less impulse control and less confidence in maintaining abstinence at discharge. Length of stay in the residential program and no diagnosis of Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV cannabis use disorder criteria predicted post-treatment cannabis use such that veterans who remained in the program longer were more likely to abstain from cannabis use following treatment, and those who did not meet DSM-IV cannabis use disorder criteria were more likely to use following treatment. CONCLUSIONS Identification of relevant risk factors and treatment processes, such as impulse control, confidence in treatment, and length of stay in treatment, provides practical recommendations for future intervention efforts. This study calls for further examination of cannabis use outcomes among veterans, particularly those participating in substance use treatment.
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Affiliation(s)
- Maha N Mian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Karen Chan Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Daniel Blonigen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304, USA
- Center for Innovation to Implementation, VA Palo Alto HCS, Palo Alto, CA 94025, USA
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2
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McReynolds JR, Wolf CP, Starck DM, Mathy JC, Schaps R, Krause LA, Hillard CJ, Mantsch JR. Role of mesolimbic cannabinoid receptor 1 in stress-driven increases in cocaine self-administration in male rats. Neuropsychopharmacology 2023; 48:1121-1132. [PMID: 37188846 PMCID: PMC10267161 DOI: 10.1038/s41386-023-01589-1] [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] [Received: 10/28/2022] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
Stress is prevalent in the lives of those with substance use disorders (SUDs) and influences SUD outcomes. Understanding the neurobiological mechanisms through which stress promotes drug use is important for the development of effective SUD interventions. We have developed a model wherein exposure to a stressor, uncontrollable electric footshock, daily at the time of cocaine self-administration escalates intake in male rats. Here we test the hypothesis that stress-induced escalation of cocaine self-administration requires the CB1 cannabinoid receptor. Male Sprague-Dawley rats self-administered cocaine (0.5 mg/kg/inf, i.v.) during 2-h sessions comprised of four 30-min self-administration components separated by 5-min shock sequences or 5-min shock-free periods for 14 days. Footshock produced an escalation of cocaine self-administration that persisted following shock removal. Systemic administration of the cannabinoid receptor type 1 (CB1R) antagonist/inverse agonist, AM251, attenuated cocaine intake only in rats with a history of stress. This effect was localized to the mesolimbic system, as intra-nucleus accumbens (NAc) shell and intra-ventral tegmental area (VTA) micro-infusions of AM251 attenuated cocaine intake only in stress-escalated rats. Cocaine self-administration, regardless of stress history, increased CB1R binding site density in the VTA, but not NAc shell. Following extinction, cocaine-primed reinstatement (10 mg/kg, ip) was increased in rats with prior footshock during self-administration. AM251 attenuated reinstatement only in rats with a stress history. Altogether, these data demonstrate that mesolimbic CB1Rs are required to escalate intake and heighten relapse susceptibility and suggest that repeated stress at the time of cocaine use regulates mesolimbic CB1R activity through a currently unknown mechanism.
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Affiliation(s)
- Jayme R McReynolds
- Department of Biomedical Sciences, Marquette University, Milwaukee, WI, USA.
- Department of Pharmacology & Systems Physiology and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Colten P Wolf
- Department of Biomedical Sciences, Marquette University, Milwaukee, WI, USA
| | - Dylan M Starck
- Department of Biomedical Sciences, Marquette University, Milwaukee, WI, USA
| | - Jacob C Mathy
- Department of Biomedical Sciences, Marquette University, Milwaukee, WI, USA
| | - Rebecca Schaps
- Department of Biomedical Sciences, Marquette University, Milwaukee, WI, USA
| | - Leslie A Krause
- Department of Pharmacology & Toxicology and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cecilia J Hillard
- Department of Pharmacology & Toxicology and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John R Mantsch
- Department of Biomedical Sciences, Marquette University, Milwaukee, WI, USA
- Department of Pharmacology & Toxicology and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Godara M, Everaert J, Sanchez-Lopez A, Joormann J, De Raedt R. Interplay between uncertainty intolerance, emotion regulation, cognitive flexibility, and psychopathology during the COVID-19 pandemic: a multi-wave study. Sci Rep 2023; 13:9854. [PMID: 37330557 PMCID: PMC10276821 DOI: 10.1038/s41598-023-36211-3] [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: 09/11/2022] [Accepted: 05/31/2023] [Indexed: 06/19/2023] Open
Abstract
The COVID-19 pandemic has created a significant mental health burden on the global population. Studies during the pandemic have shown that risk factors such as intolerance of uncertainty and maladaptive emotion regulation are associated with increased psychopathology. Meanwhile, protective factors such as cognitive control and cognitive flexibility have been shown to protect mental health during the pandemic. However, the potential pathways through which these risk and protective factors function to impact mental health during the pandemic remain unclear. In the present multi-wave study, 304 individuals (18 years or older, 191 Males), residing in the USA during data collection, completed weekly online assessments of validated questionnaires across a period of five weeks (27th March 2020-1st May 2020). Mediation analyses revealed that longitudinal changes in emotion regulation difficulties mediated the effect of increases in intolerance of uncertainty on increases in stress, depression, and anxiety during the COVID-19 pandemic. Further, individual differences in cognitive control and flexibility moderated the relationship between intolerance of uncertainty and emotion regulation difficulties. While intolerance of uncertainty and emotion regulation difficulties emerged as risk factors for mental health, cognitive control and flexibility seems to protect against the negative effects of the pandemic and promote stress resilience. Interventions aimed at enhancing cognitive control and flexibility might promote the protection of mental health in similar global crises in the future.
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Affiliation(s)
- Malvika Godara
- Department of Experimental, Clinical & Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany.
| | - Jonas Everaert
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Alvaro Sanchez-Lopez
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, USA
| | - Rudi De Raedt
- Department of Experimental, Clinical & Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
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Hernández-Posadas A, Lommen MJJ, de la Rosa Gómez A, Bouman TK, Mancilla-Díaz JM, del Palacio González A. Transdiagnostic factors in symptoms of depression and post-traumatic stress: a systematic review. CURRENT PSYCHOLOGY 2023:1-16. [PMID: 37359653 PMCID: PMC10226442 DOI: 10.1007/s12144-023-04792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
The current systematic review sought to identify quantitative empirical studies that focused on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination, and their relation with depression and post-traumatic stress disorder (PTSD). The overall research aim was to examine the relationship between these transdiagnostic factors and their relation with depression and PTSD symptoms. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Out of the 768 articles initially identified, 55 met the inclusion criteria for the current review. The results determined that intolerance of uncertainty is indirectly related to depression and PTSD symptoms, mainly through other factors including emotion dysregulation and rumination. Additionally, emotional dysregulation is a significant predictor of both depression and PTSD symptoms. Rumination is a robust factor related to depression and PTSD symptoms, this relationship was significant in cross-sectional and longitudinal studies. This review provides evidence on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination in the relationship with depression and PTSD symptoms.
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Affiliation(s)
- Alejandrina Hernández-Posadas
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Av. De los Barrios Núm. 1, Los Reyes Iztacala, Torre de Tutorías, 2do. Piso, Cubículo 22, Edo. de Mexico 54090 Tlalnepantla, Mexico
| | - Miriam J. J. Lommen
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Anabel de la Rosa Gómez
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Av. De los Barrios Núm. 1, Los Reyes Iztacala, Torre de Tutorías, 2do. Piso, Cubículo 22, Edo. de Mexico 54090 Tlalnepantla, Mexico
| | - Theo K. Bouman
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Juan Manuel Mancilla-Díaz
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Av. De los Barrios Núm. 1, Los Reyes Iztacala, Torre de Tutorías, 2do. Piso, Cubículo 22, Edo. de Mexico 54090 Tlalnepantla, Mexico
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Dirican AH, Kozak ED, Kavakcı Ö, Sönmez B. The Association of Child Abuse Experiences and Intolerance of Uncertainty in Young Adults. Psychiatry 2023; 86:214-228. [PMID: 37130031 DOI: 10.1080/00332747.2023.2205800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objective: Drawing upon the identity disruption model, we investigated the association between child abuse experiences (emotional, physical, and sexual) and intolerance of uncertainty. We also addressed demographic differences in uncertainty intolerance in this study. Methods: Using online survey questionnaires, we collected data from a sample of 302 young adults in Turkey. The data were analyzed using confirmatory factor analysis, structural equation modeling, one-way analysis of variance, and independent samples t-test. Results: The results showed that of the three types of child abuse analyzed, only emotional abuse was significantly and positively associated with intolerance of uncertainty. In contrast, age was negatively associated with intolerance of uncertainty. Regarding demographic differences, we found that the level of intolerance of uncertainty differed based on young adults' gender, psychiatric diagnosis, and education. Specifically, our findings indicated that intolerance of uncertainty is significantly higher in females compared to males. It is also significantly higher in young adults with a diagnosis for psychiatric disorders than those without. Moreover, intolerance of uncertainty is significantly higher in young adults who have a high school graduate degree than their undergraduate and graduate counterparts. We discussed how child abuse is associated with heightened intolerance of uncertainty in young adulthood as well as why demographic differences may exist in uncertainty intolerance. Conclusions: The present study expanded the existing research on the psychological consequences of childhood abuse experiences by linking child abuse to intolerance of uncertainty. Particularly, exposure to emotional abuse in early life can be a risk factor to cope with uncertainty in later life.
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Probert-Lindström S, Perrin S. An examination of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in adults in routine psychiatric care. Acta Psychol (Amst) 2023; 235:103902. [PMID: 37004421 DOI: 10.1016/j.actpsy.2023.103902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
AIM A person's ability to tolerate negative emotional states (Distress Tolerance - DT), uncertainty in their everyday lives (Intolerance of Uncertainty - IU), and a tendency to appraise their own feelings of anxiety as harmful (Anxiety Sensitivity - AS) have all been identified as vulnerability factors for anxiety and depressive disorders. However, the relationship between these variables and broader aspects of psychiatric symptom severity in participants recruited from routine care remains unclear. METHOD The Distress Tolerance Scale (DTS), Anxiety Sensitivity Scale-3 (ASI-3), and Intolerance of Uncertainty Scale-Short Form (IUS-12) were administered to 91 patients receiving treatment at the Lund Outpatient Psychiatric Clinic. Data was collected from their medical records about their psychiatric history and scores on the Brief Symptom Inventory (BSI). The relationship between total scores on the DTS, ASI-3, IUS-12 and BSI were evaluated via correlations and regression analyses. RESULTS DTS, ASI-3, and IUS-12 total scores correlated in the moderate to large range, and consistent with previous literature, were moderately to strongly correlated with the severity of self-reported depression, anxiety and overall symptoms (BSI). Regression analyses indicated that together, scores on the DTS, ASI-3 and IUS-12 explained moderate levels of variance in BSI symptom scores, with DTS scores showing the strongest associations. These findings suggest that further studies are needed to examine the construct and criterion validity of the three scales. Further validation of these Swedish-language are also warranted.
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Wesner E, Pavuluri A, Norwood E, Schmidt B, Bernat E. Evaluating competing models of distress tolerance via structural equation modeling. J Psychiatr Res 2023; 162:95-102. [PMID: 37121119 DOI: 10.1016/j.jpsychires.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023]
Abstract
Distress Tolerance (DT) is a transdiagnostic risk and maintenance factor implicated in a wide range of internalizing spectrum (INT) disorders. DT is commonly conceptualized as a higher-order construct, yet its lower-order dimensions are still debated. While the tolerance of negative emotions, frustration, and physical discomfort are widely considered to be central features of DT, the inclusions of intolerance of uncertainty (IU) and anxiety sensitivity (AS) are disputed. This study is the first to compare the two leading hierarchical models of DT directly. We also propose and test a DT model which includes IU and AS as lower-order dimensions. This "combined" model drew from the prior hierarchical theories and subsequent research demonstrating IU and AS to be highly correlated. To evaluate the competing models of DT, structured equation modeling was used to construct latent models representing each leading model and our novel "combined" model. A clinical sample was analyzed (N = 278), with participants having completed self-report scales measuring DT's theorized lower-order dimensions. Of the proposed models, the "combined" model demonstrated the best fit indices in the context of INT. A regression model with our "combined" model indicated that even after its shared variance with the Distress Intolerance Index (DII) was removed, it still had a moderate association with INT (β = 0.805, p < .01). This suggests that the only extant measure of the higher-order DT construct, the DII, fails to capture considerable variance in its latent structure. Future directions are discussed.
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Nickerson A, Hoffman J, Keegan D, Kashyap S, Argadianti R, Tricesaria D, Pestalozzi Z, Nandyatama R, Khakbaz M, Nilasari N, Liddell B. Intolerance of uncertainty, posttraumatic stress, depression, and fears for the future among displaced refugees. J Anxiety Disord 2023; 94:102672. [PMID: 36657336 DOI: 10.1016/j.janxdis.2023.102672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The vast majority of the 100 million forcibly displaced persons worldwide live in a state of prolonged uncertainty with limited resettlement prospects and access to resources. Little is known, however, regarding how refugees and asylum-seekers cope with this uncertainty. METHODS In this study, we investigated the longitudinal association between a measure of how people cope with uncertainty (intolerance of uncertainty (IU)), fears for the future, posttraumatic stress disorder (PTSD) symptoms and depression symptoms. A sample of 1,237 refugees displaced in Indonesia completed an online survey in Arabic, Farsi, Dari, Somali or English at two time-points six-months apart. RESULTS Results indicated that greater IU-inhibitory anxiety (IU-IA or impairment related to uncertainty) was associated with subsequent increases in PTSD and depression symptoms and fears for the future. Greater PTSD symptoms and fears for the future were associated with increases in IU-prospective anxiety (IU-PA or distress related to uncertainty), and greater depression symptoms were associated with increases in IU-IA. DISCUSSION These findings provide evidence for the mechanistic role of IU in psychological symptoms amongst displaced refugees. Results underscore the importance of policies to reduce uncertainty in displacement environments, and highlight IU as a potential intervention target to help refugees cope with protracted displacement.
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Affiliation(s)
| | - Joel Hoffman
- School of Psychology, UNSW Sydney, NSW, Australia.
| | - David Keegan
- HOST International, 31 Grose Street, Parramatta, NSW, Australia.
| | | | - Rizka Argadianti
- HOST International, 31 Grose Street, Parramatta, NSW, Australia; SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Menteng, Jakarta Pusat 10320, Indonesia.
| | - Diah Tricesaria
- HOST International, 31 Grose Street, Parramatta, NSW, Australia.
| | - Zico Pestalozzi
- SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Menteng, Jakarta Pusat 10320, Indonesia.
| | - Randy Nandyatama
- Department of International Relations, Gadjah Mada University Yogyakarta, Bulaksumur, Yogyakarta 55281, Indonesia.
| | - Mitra Khakbaz
- HOST International, 31 Grose Street, Parramatta, NSW, Australia.
| | - Nindita Nilasari
- Department of International Relations, Gadjah Mada University Yogyakarta, Bulaksumur, Yogyakarta 55281, Indonesia.
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Killeen TK, Wen CC, Neelon B, Baker N. Predictors of Treatment Completion among Women Receiving Integrated Treatment for Comorbid Posttraumatic Stress and Substance Use Disorders. Subst Use Misuse 2023; 58:500-511. [PMID: 36705433 DOI: 10.1080/10826084.2023.2170183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Retention in treatment for individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is an area of concern in treatment outcome studies. The current study explores key variables related to retention in a group of women with comorbid PTSD and SUD enrolled in community SUD treatment randomized to eight weekly sessions of a trauma adapted mindfulness-based relapse prevention (TA-MBRP) or an integrated coping skills (ICS) group intervention. Methods: Two unadjusted and adjusted logistic discrete failure time (DFT) models were fit to examine associations between participants and the time (in weeks) to treatment completion status. Key covariates of interest, including time-varying PTSD Symptom Scale-Self Report (PSS) total score, time-varying Five Factors Mindfulness Questionnaire (FFMQ) total score, group assignment, baseline endorsements of substance use and demographics such as age, race and employment status were fit into the model. Results: In the adjusted PSS model, increased levels of PTSD symptom severity (PSS) scores at week 5 and 7 (PSS OR: 1:06: OR 1.13, respectively) were associated with higher odds of non-completion. In the FFMQ model, increased levels of FFMQ scores at week 6 (OR: 0:92) were associated with lower odds of non-completion. In both models, assignment to the ICS control group and unemployment were associated with lower odds of completion and baseline use of cocaine and sedatives were associated with higher odds of completion. Conclusion: Monitoring PTSD symptom severity and measures of mindfulness can inform providers on strategies to enhance retention early in treatment for individuals with comorbid PTSD/SUD.ClinicalTrials.gov # NCT02755103.
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Affiliation(s)
- Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chun-Che Wen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathanial Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Radoman M, Gorka SM. Intolerance of uncertainty and functional connectivity of the anterior insula during anticipation of unpredictable reward. Int J Psychophysiol 2023; 183:1-8. [PMID: 36122824 PMCID: PMC11062179 DOI: 10.1016/j.ijpsycho.2022.09.003] [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] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 01/04/2023]
Abstract
Individuals with high intolerance of uncertainty (IU) tend to display maladaptive cognitive, behavioral, physiological, and/or neural responses during anticipation of uncertain or ambiguous outcomes, both positive and negative in valence. Importantly, high IU has been proposed as a key transdiagnostic phenotypic risk factor for the onset and maintenance of several psychiatric disorders. Within the context of reward processing, high IU has been related to dysfunctional reward anticipation, which may be mediated by hyperactive anterior insula (AIC) response to uncertainty. The present study further investigated the relationship between the AIC and IU by examining the association between individual differences in IU and task-based functional connectivity of the right AIC using functional magnetic resonance imaging (fMRI). Participants (N = 171) completed a self-report measure of IU and a reward anticipation task during fMRI. Generalized psychophysiological interaction (gPPI) analyses were performed with a seed in the right AIC. In the U-threat model, we found that greater self-reported levels of IU were correlated with increased functional connectivity between the right AIC and the dorsal anterior cingulate cortex (dACC) and the right dorsolateral prefrontal cortex (dlPFC). In the P-threat model, we did not find these associations, perhaps indicating that they may be more robust during uncertainty. These preliminary findings suggest that parts of salience and central executive control networks may be impacted by and underlie the expression of IU. Future studies should examine the generalizability of these findings to clinical populations and investigate how disruption of these functional networks may contribute to psychopathology.
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Affiliation(s)
- Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor Street, Chicago, IL 60612, USA; Department of Anatomy and Cell Biology, University of Illinois at Chicago, 840 S Wood Street, Chicago, IL 60612, USA; The Graduate Program in Neuroscience, University of Illinois at Chicago, 840 S Wood Street, Chicago, IL 60612, USA.
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University, 1670 Upham Drive, Columbus, OH 43205, USA
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Nickerson A, Hoffman J, Keegan D, Kashyap S, Tricesaria D, Pestalozzi Z, Argadianti Rachmah R, Nandyatama R, Khakbaz M, Nilasari N, Liddell BJ. Context, coping, and mental health in refugees living in protracted displacement. J Trauma Stress 2022; 35:1769-1782. [PMID: 36268717 DOI: 10.1002/jts.22885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
There is currently an unprecedented number of forcibly displaced people worldwide. Little is known, however, about how external stressors and internal coping strategies intersect to influence mental health in displaced refugees, particularly whether specific types of coping strategies are more or less effective across different levels of external stress. This study aimed to understand whether positive and negative internal coping strategies were differentially associated with mental health across high and low levels of external stressors in displaced refugees. Participants were 1,216 refugees living in Indonesia who completed an online survey indexing demographic characteristics, exposure to ongoing stressors, positive psychological coping strategies (i.e., cognitive flexibility, self-efficacy, and hope), negative psychological coping strategies (i.e., rumination and intolerance of uncertainty), psychological symptoms (i.e., posttraumatic stress disorder, depression, and anxiety) and mental health-related quality of life. Participants (27.3% female, Mage = 30.52 years) were from Arabic-, Farsi-, Tamil-, Somali-, Dari-, and English-speaking backgrounds. Results of latent moderated structural equation modeling indicated that the association between negative psychological coping strategies and poorer mental health was stronger at higher levels of stress, whereas the association between positive psychological coping strategies and better quality of life was stronger at lower levels of stress. These findings provide evidence in support of tailored approaches that integrate interventions addressing external stressors and internal coping strategies to support positive mental health and enhanced quality of life in displaced refugees.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Joel Hoffman
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Shraddha Kashyap
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Zico Pestalozzi
- SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Jakarta, Indonesia
| | - Rizka Argadianti Rachmah
- HOST International, Parramatta, Australia.,SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Jakarta, Indonesia
| | - Randy Nandyatama
- School of International Relations, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nindita Nilasari
- School of International Relations, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, Australia
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The perception and impact of emotional trauma upon active duty military personnel. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Parker SC, Ahrens AH. (Just Thinking of) Uncertainty Increases Intolerance of Uncertainty. JOURNAL OF INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1027/1614-0001/a000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Intolerance of uncertainty is a far-reaching – yet not widely examined – construct with clinical and nonclinical associations. The current study implemented a brief reflection on uncertainty hypothesized to increase tolerance of uncertainty. The group who engaged in the reflection ( n = 50) was compared to an active control condition ( n = 50). Results demonstrated the opposite of the primary hypothesis: simply reflecting on uncertainty significantly increased intolerance of uncertainty (vs. tolerance of uncertainty). Results also demonstrated that those higher in mindfulness were higher in tolerance of uncertainty, with the “nonreactivity” factor of mindfulness contributing unique variance. These findings suggest multiple factors that might contribute to both tolerance and intolerance of uncertainty. This study indicates that investigations of interventions that include training in mindfulness and its component of nonreactivity might be particularly warranted.
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Affiliation(s)
- Suzanne C. Parker
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, American University, Washington, DC, USA
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Benuto LT, Yang Y, Bennett N, Lancaster C. Distress Tolerance and Emotion Regulation as Potential Mediators Between Secondary Traumatic Stress and Maladaptive Coping. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP11557-NP11581. [PMID: 33076751 DOI: 10.1177/0886260520967136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The extant literature has illustrated that protective service workers experience negative repercussions associated with their job (including the development of secondary traumatic stress; STS) and may utilize maladaptive coping mechanisms. Developing an improved understanding of factors that might explain the relationship between STS and the utilization of maladaptive coping mechanisms is warranted. This study sought to examine emotion regulation and distress tolerance as potential mediators between STS and the utilization of maladaptive coping mechanisms. Participants were 152 elder protective service workers and 105 child protective service workers who completed an online survey of self-report measures of emotion regulation, distress tolerance, STS, and coping behaviors. A parallel multiple mediator model was analyzed using structural equation modeling (SEM) to examine the hypothesis that distress tolerance and emotion regulation would mediate the relationship between STS and the utilization of maladaptive coping. Our hypothesis was partially supported as the effect of STS on maladaptive coping was mediated by emotion regulation but not by distress tolerance. The results from this study have both prevention and intervention implications. From a prevention perspective, efforts could be directed at teaching emotion regulation skills to those at risk for developing STS as a mechanism for decreasing the probability of denial, substance use, behavioral disengagement, and self-blame that may occur as a consequence of STS. From an intervention perspective, some of the negative sequelae of exposure to STS may be averted by teaching EPS and CPS workers who present with STS symptoms, emotion regulation skills.
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Leonard SJ, Zegel M, Venta A, Vujanovic AA. Insecure Adult Attachment Style and PTSD Symptom Severity among Firefighters: The Role of Distress Tolerance. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2022; 32:592-610. [PMID: 37377579 PMCID: PMC10292721 DOI: 10.1080/10926771.2022.2078681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/07/2022] [Accepted: 05/01/2022] [Indexed: 06/29/2023]
Abstract
Trauma exposure and posttraumatic stress disorder (PTSD) symptoms among firefighters are prevalent and well-documented. Insecure adult attachment style (AAS) and distress tolerance (DT) present two factors with demonstrated relevance to the etiology and maintenance of PTSD. Few studies have examined these constructs in relation to PTSD symptomatology among firefighter populations. The present investigation examined the indirect effect of insecure romantic AAS (i.e., anxious AAS, avoidant AAS) on PTSD symptom severity through DT among firefighters. Exploratory analyses examined this model with each of the PTSD symptom clusters as outcomes. The sample was comprised of 105 firefighters (Mage=40.43, SD=9.15, 95.2% male) recruited from various departments in the southern U.S. An indirect effect was calculated using 10,000 bootstrapped samples. Indirect effects models in the primary analyses were significant when both anxious AAS (β=.20, SE=.10, CI=.06-.43) and avoidant AAS (β=.28, SE=.12, CI=.08-.54) were evaluated as predictors. Effects were evident after accounting for gender, relationship status, years of fire service, and trauma load (i.e., number of potentially traumatic event types experienced). Exploratory analyses revealed that anxious and avoidant AAS are both indirectly related to the PTSD intrusion, negative alterations in cognitions and mood, and alterations in arousal and reactivity symptom clusters through DT. Anxious AAS also demonstrated an indirect association with PTSD avoidance symptoms through DT. Attachment styles may influence PTSD symptoms among firefighters through a firefighter's perceived ability to withstand emotional distress. This line of inquiry has potential to inform specialized intervention programs for firefighters. Clinical and empirical implications are discussed.
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PTSD Symptoms, Intolerance of Uncertainty, and Alcohol-Related Outcomes Among Trauma-Exposed College Students. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Hromova HM. Interrelation between intolerance of uncertainty and the time perspective profile in the military. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2022; 10:321-332. [PMID: 38013736 PMCID: PMC10653556 DOI: 10.5114/cipp.2021.111984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/04/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Time perspective (TP) theory suggests that people tend to categorize their experience in terms of the past, the present, and the future. Studies have shown that a balanced TP profile supports well-being while misbalance in the TP profile is associated with various psychopathology. On the other hand, an intolerance of uncertainty (IU) underpins a variety of affective disorders. There are still a lot of questions about the relationship between IU and the TP. The purpose of this study was to clarify the interrelation between the time perspective distortion and intolerance of uncertainty level and to examine the degree to which IU and TP scales are associated with posttraumatic stress symptoms in a military sample. PARTICIPANTS AND PROCEDURE The sample of servicemen (N = 129) completed ZTPI, the IUS-12 and PCL-5 questionnaires. Correlational and regression analyses were conducted with IU scores, TP scales and DBTP and DBTP-r coefficients. RESULTS IU total score correlates with Past Negative (PN), Present Hedonistic (PH), Present Fatalistic (PF), and Future (F) time perspectives in the military sample. Groups that differ in the level of IU have a significant difference in Past Negative TP. Regression analysis models using DBTP as well as DBTP-r coefficients showed similar results. Inhibitory IU, not Prospective IU, turned out to be a predictor of post-traumatic stress symptoms in this military, non-clinical sample. CONCLUSIONS Further studies should determine directions of associations between intolerance of uncertainty and time perspective.
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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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19
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Hunt C, Exline JJ, Fletcher TL, Teng EJ. Intolerance of uncertainty prospectively predicts the transdiagnostic severity of emotional psychopathology: Evidence from a Veteran sample. J Anxiety Disord 2022; 86:102530. [PMID: 35033969 DOI: 10.1016/j.janxdis.2022.102530] [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: 04/30/2021] [Revised: 11/01/2021] [Accepted: 01/09/2022] [Indexed: 11/16/2022]
Abstract
Intolerance of uncertainty (IU) has been conceptualized as a transdiagnostic vulnerability for emotional psychopathology, but few studies have tested whether it prospectively predicts emotional psychopathology, and none have utilized transdiagnostic and clinician-rated outcomes. To fill this gap, the present study tested whether IU prospectively predicted the clinician-rated severity of transdiagnostic emotional psychopathology six months later in a treatment-seeking Veteran sample. Participants completed the Intolerance of Uncertainty 12-item scale (IUS-12) and the Structured Clinical Interview for the DSM-5 (SCID-5) at Time 1 and again six-months later (Time 2); assessed emotional disorders included both anxiety-related disorders (i.e., post-traumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, specific phobia) and depressive conditions (i.e., major depressive disorder and persistent depressive disorder). Linear regression analyses revealed a bidirectional prospective relation between IU and emotional psychopathology, wherein higher Time 1 IUS-12 predicted greater Time 2 emotional disorder severity and greater Time 1 emotional disorder severity predicted higher Time 2 IUS-12. Follow-up analyses revealed that IU prospectively predicted the maintenance (but not the development) of anxiety-related issues, whereas prediction of Time 2 depression was nullified when controlling for Time 1 anxiety pathology. These findings implicate IU as a transdiagnostic vulnerability for emotional psychopathology and suggest the construct can be particularly useful as a treatment target and prognostic indicator for anxiety-related conditions.
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Affiliation(s)
- Christopher Hunt
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA
| | - Julie J Exline
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Rd., Cleveland, OH 44106, USA
| | - Terri L Fletcher
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, 2450 Holcombe Blvd., Houston, TX 77030, USA
| | - Ellen J Teng
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, 2450 Holcombe Blvd., Houston, TX 77030, USA.
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20
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Vujanovic AA, Webber HE, McGrew SJ, Green CE, Lane SD, Schmitz JM. Distress tolerance: prospective associations with cognitive-behavioral therapy outcomes in adults with posttraumatic stress and substance use disorders. Cogn Behav Ther 2022; 51:326-342. [PMID: 34994673 DOI: 10.1080/16506073.2021.2007995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
74Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; Mage = 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e. proportion of number of use days to total number of days between two final treatment sessions).
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Affiliation(s)
- Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Heather E Webber
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shelby J McGrew
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Charles E Green
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Scott D Lane
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
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21
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Akbari M, Hosseini ZS, Seydavi M, Zegel M, Zvolensky MJ, Vujanovic AA. Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis. Cogn Behav Ther 2021; 51:42-71. [PMID: 34279189 DOI: 10.1080/16506073.2021.1942541] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants (Mage = 29.96, SD = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude (r = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | | | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Maya Zegel
- 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, Texas, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
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22
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Kennedy C, Deane FP, Chan AY. Intolerance of uncertainty and psychological symptoms among people with a missing loved one: Emotion regulation difficulties and psychological inflexibility as mediators. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Caccamise A, Van Newenhizen E, Mantsch JR. Neurochemical mechanisms and neurocircuitry underlying the contribution of stress to cocaine seeking. J Neurochem 2021; 157:1697-1713. [PMID: 33660857 DOI: 10.1111/jnc.15340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/12/2022]
Abstract
In individuals with substance use disorders, stress is a critical determinant of relapse susceptibility. In some cases, stressors directly trigger cocaine use. In others, stressors interact with other stimuli to promote drug seeking, thereby setting the stage for relapse. Here, we review the mechanisms and neurocircuitry that mediate stress-triggered and stress-potentiated cocaine seeking. Stressors trigger cocaine seeking by activating noradrenergic projections originating in the lateral tegmentum that innervate the bed nucleus of the stria terminalis to produce beta adrenergic receptor-dependent regulation of neurons that release corticotropin releasing factor (CRF) into the ventral tegmental area (VTA). CRF promotes the activation of VTA dopamine neurons that innervate the prelimbic prefrontal cortex resulting in D1 receptor-dependent excitation of a pathway to the nucleus accumbens core that mediates cocaine seeking. The stage-setting effects of stress require glucocorticoids, which exert rapid non-canonical effects at several sites within the mesocorticolimbic system. In the nucleus accumbens, corticosterone attenuates dopamine clearance via the organic cation transporter 3 to promote dopamine signaling. In the prelimbic cortex, corticosterone mobilizes the endocannabinoid, 2-arachidonoylglycerol (2-AG), which produces CB1 receptor-dependent reductions in inhibitory transmission, thereby increasing excitability of neurons which comprise output pathways responsible for cocaine seeking. Factors that influence the role of stress in cocaine seeking, including prior history of drug use, biological sex, chronic stress/co-morbid stress-related disorders, adolescence, social variables, and genetics are discussed. Better understanding when and how stress contributes to drug seeking should guide the development of more effective interventions, particularly for those whose drug use is stress related.
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Affiliation(s)
- Aaron Caccamise
- Graduate Program in Neuroscience, Marquette University, Milwaukee, WI, USA
| | - Erik Van Newenhizen
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John R Mantsch
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA
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24
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Williamson L, Dell CA, Osgood N, Chalmers D, Lohnes C, Carleton N, Asmundson G. Examining Changes in Posttraumatic Stress Disorder Symptoms and Substance Use Among a Sample of Canadian Veterans Working with Service Dogs: An Exploratory Patient- Oriented Longitudinal Study. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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25
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McGuire AP, Hayden CL, Zambrano-Vazquez L, Connolly KM. Examining the Link Between Intolerance of Uncertainty and Positive and Negative Urgency in Veterans With Comorbid Posttraumatic Stress Disorder and Substance Use Disorders. J Nerv Ment Dis 2021; 209:82-84. [PMID: 33323793 DOI: 10.1097/nmd.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are highly comorbid among the veteran population. Impulsivity, particularly negative and positive urgency, are prevalent within this dual-diagnosis population and associated with negative outcomes. One possible correlate of negative/positive urgency is intolerance of uncertainty (IU). IU is associated with exacerbated PTSD symptom severity and increased risk for substance use. However, few studies have examined the link between IU and negative/positive urgency in dual-diagnosis populations. This study aimed to examine whether there was a significant association between trait IU and baseline negative and positive urgency in veterans seeking treatment for both PTSD and SUD. In a sample of 114 veterans from a 6-week residential treatment program, IU was significantly associated with higher negative and positive urgency. Further research is warranted to extend these findings and examine whether IU plays an important role in negative/positive urgency for dual-diagnosis populations.
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Affiliation(s)
| | - Candice L Hayden
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler
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26
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Preston TJ, Morabito DM, Albanese BJ, Schmidt NB. Distress intolerance mediates attentional control on posttraumatic stress symptoms: Evidence from two clinical samples. J Psychiatr Res 2020; 130:447-454. [PMID: 32911357 DOI: 10.1016/j.jpsychires.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/18/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
Theoretical models emphasize the importance of both affective and cognitive risk factors in the development of posttraumatic stress symptoms (PTSS). Two such factors predicting PTSS have been studied extensively: distress intolerance (DI) - an affective factor indicative of the ability to tolerate negative affective states - and attentional control (AC), a cognitive factor reflecting the ability to flexibly shift and maintain attention to goal-relevant tasks. Previous work primarily highlights the independent contributions of DI and AC and their interaction to predict PTSS. Some models, however, suggest a mediational pathway such that AC indirectly affects PTSS via diminished DI. The current paper addressed this gap by first attempting to replicate prior findings, while also exploring this mediation model. Results were examined in two clinical samples - a trauma-exposed sample of adults (study 1; N = 73) and trauma-exposed treatment-seeking adults (study 2; N = 204). Results partially supported our hypotheses; both studies failed to replicate prior moderation findings, but our mediational hypothesis was supported in both samples. Low AC appears to decrease an individual's tolerance for distressing situations, which in turn increases the severity of PTSS. Results suggest that PTSD treatments may benefit by incorporating components of AC, DI, or a combination of the two to mitigate PTSS. Taken together, this study provides a novel examination of how cognitive and affective risk factors, namely AC and DI, work in tandem to increase PTSS.
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27
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Kearns NT, Contractor AA, Weiss NH, Blumenthal H. Coping strategy utilization among posttraumatic stress disorder symptom severity and substance use co-occurrence typologies: A latent class analysis. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2020; 13:929-939. [PMID: 32897090 DOI: 10.1037/tra0000964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE There is a lack of research on primary prevention of posttraumatic stress disorder (PTSD) symptoms and substance use among trauma-exposed populations. To guide the development of more effective prevention efforts, the current study sought to identify underlying coping mechanisms that impact PTSD-substance use co-occurrence. METHOD A person-centered analytic approach (latent class analysis) examined PTSD-substance use co-occurrence typologies (classes) and identified theoretically adaptive (e.g., active coping) and maladaptive (e.g., denial) coping strategies that differentiated between classes among a sample of 1,270 trauma-exposed participants (Mage = 20.71, 73.5% female, 45.7% White). RESULTS Latent class analysis identified five distinct typologies, reflective of extant epidemiological and etiological work. Generally, behavioral disengagement and self-blame coping increased the likelihood of being in more severe PTSD-illicit substance use (e.g., cocaine) comorbidity classes. Positive reframing and planning differentiated between low and moderate illicit substance typologies with moderate PTSD severity. Venting, acceptance, and self-distraction differentiated between asymptomatic and moderate PTSD severity typologies with low illicit substance use. CONCLUSIONS Findings identify general coping strategies associated with increased likelihood of being in more severe comorbidity typologies, as well as several unique coping strategies associated with risk of transitioning between low/moderate PTSD and illicit substance use classes. Relevant interventions (e.g., trauma psychoeducation, guilt-reduction therapy, psychological first aid) that may be targets for future prevention-oriented work are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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28
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DeSerisy M, Musial A, Comer JS, Roy AK. Functional connectivity of the anterior insula associated with intolerance of uncertainty in youth. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:493-502. [PMID: 32124254 PMCID: PMC7272284 DOI: 10.3758/s13415-020-00780-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intolerance of uncertainty (IU) is a trait characteristic marked by distress in the face of insufficient information. Elevated IU has been implicated in the development and maintenance of anxiety disorders, particularly during adolescence, which is characterized by dramatic neural maturation and the onset of anxiety disorders. Previous task-based work implicates the bilateral anterior insula in IU. However, the association between anterior insula intrinsic functional connectivity (iFC) and IU has not been examined in adolescents. Fifty-eight healthy youth (mean age = 12.56; 55% boys) completed the Intolerance of Uncertainty Scale for Children (IUSC-12) and a 6-minute resting state fMRI scan. Group-level analyses were conducted using a random-effects, ordinary least-squares model, including IUSC-12 scores (Total, Inhibitory subscale, Prospective subscale), and three nuisance covariates (age, sex, and mean framewise displacement). IUSC-12 Inhibitory subscale scores were predictive of iFC between the left and right anterior insula and right prefrontal regions. IUSC-12 Prospective subscale scores significantly predicted iFC between the anterior insula and the anterior cingulate cortex. IUSC-12 total scores did not predict significant iFC of the bilateral anterior insula. Follow-up analyses, including anxiety (MASC Total Score) in the models, failed to find significant results. This could suggest that the associations found between IUSC-12 scores and anterior insula iFC are not unique to IU and, rather, reflect a broader anxiety-related connectivity pattern. Further studies with larger samples are needed to tease apart unique associations. These findings bear significance in contributing to the literature evaluating the neural correlates of risk factors for anxiety in youth.
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Affiliation(s)
- Mariah DeSerisy
- Fordham University, Dealy Hall 436, 441 East Fordham Road, Bronx, NY, 10458, USA.
| | - Alec Musial
- Fordham University, Dealy Hall 436, 441 East Fordham Road, Bronx, NY, 10458, USA
| | | | - Amy K Roy
- Fordham University, Dealy Hall 436, 441 East Fordham Road, Bronx, NY, 10458, USA
- Hassenfeld Children's Hospital of New York at NYU Langone Child Study Center, New York, NY, USA
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29
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Angehrn A, Krakauer RL, Carleton RN. The Impact of Intolerance of Uncertainty and Anxiety Sensitivity on Mental Health Among Public Safety Personnel: When the Uncertain is Unavoidable. COGNITIVE THERAPY AND RESEARCH 2020; 44:919-930. [PMID: 32848288 PMCID: PMC7434797 DOI: 10.1007/s10608-020-10107-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Public safety personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, public safety communications officials) are regularly exposed to potentially traumatic events and considerable uncertainty as part of their employment. Canadian PSP screen positively for mental disorders at much higher rates than the general population. Intolerance of uncertainty (IU) and anxiety sensitivity (AS) are empirically-supported vulnerability factors associated with the development and maintenance of mental disorders. METHODS The present study was designed to assess IU and AS across PSP-a population regularly encountering uncertainty-with and without mental disorders (n = 4304; 33.3% women), and across normative clinical, community, and undergraduate samples. Further, the study examined the relationship between IU and AS and mental disorders among PSP. RESULTS There were significant differences across groups on IU and AS scores (ps < .001). All PSP, with and without a positive screen for a mental disorder, reported lower IU and AS than clinical samples; however, PSP without mental disorders reported lower IU and AS than all other groups (ps < .001). CONCLUSION Increased resilience or the development of coping skills to manage regular exposures to uncertain threat may help explain why PSP reported low levels of IU and AS despite higher prevalence of mental disorders. Implications for PSP training and treatment are discussed.
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Affiliation(s)
- Andréanne Angehrn
- Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - Rachel L Krakauer
- Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - R Nicholas Carleton
- Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
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30
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Sun D, Gold AL, Swanson CA, Haswell CC, Brown VM, Stjepanovic D, LaBar KS, Morey RA. Threat-induced anxiety during goal pursuit disrupts amygdala-prefrontal cortex connectivity in posttraumatic stress disorder. Transl Psychiatry 2020; 10:61. [PMID: 32066690 PMCID: PMC7026403 DOI: 10.1038/s41398-020-0739-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 12/22/2022] Open
Abstract
To investigate how unpredictable threat during goal pursuit impacts fronto-limbic activity and functional connectivity in posttraumatic stress disorder (PTSD), we compared military veterans with PTSD (n = 25) vs. trauma-exposed control (n = 25). Participants underwent functional magnetic resonance imaging (fMRI) while engaged in a computerized chase-and-capture game task that involved optimizing monetary rewards obtained from capturing virtual prey while simultaneously avoiding capture by virtual predators. The game was played under two alternating contexts-one involving exposure to unpredictable task-irrelevant threat from randomly occurring electrical shocks, and a nonthreat control condition. Activation in and functional connectivity between the amygdala and ventromedial prefrontal cortex (vmPFC) was tested across threat and nonthreat task contexts with generalized psychophysiological interaction (gPPI) analyses. PTSD patients reported higher anxiety than controls across contexts. Better task performance represented by successfully avoiding capture by predators under threat compared with nonthreat contexts was associated with stronger left amygdala-vmPFC functional connectivity in controls and greater vmPFC activation in PTSD patients. PTSD symptom severity was negatively correlated with vmPFC activation in trauma-exposed controls and with right amygdala-vmPFC functional connectivity across all participants in the threat relative to nonthreat contexts. The findings showed that veterans with PTSD have disrupted amygdala-vmPFC functional connectivity and greater localized vmPFC processing under threat modulation of goal-directed behavior, specifically related to successfully avoiding loss of monetary rewards. In contrast, trauma survivors without PTSD relied on stronger threat-modulated left amygdala-vmPFC functional connectivity during goal-directed behavior, which may represent a resilience-related functional adaptation.
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Affiliation(s)
- Delin Sun
- grid.26009.3d0000 0004 1936 7961Duke Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC USA ,Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham, NC USA
| | - Andrea L. Gold
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA ,grid.281318.10000 0004 0443 4869Pediatric Anxiety Research Center, Bradley Hospital, Riverside, RI USA
| | - Chelsea A. Swanson
- grid.26009.3d0000 0004 1936 7961Duke Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC USA ,Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham, NC USA
| | - Courtney C. Haswell
- grid.26009.3d0000 0004 1936 7961Duke Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC USA ,Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham, NC USA
| | - Vanessa M. Brown
- grid.438526.e0000 0001 0694 4940Department of Psychology, Virginia Polytechnic Institute, Roanoke, VA USA
| | - Daniel Stjepanovic
- grid.26009.3d0000 0004 1936 7961Duke Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC USA ,Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham, NC USA
| | | | - Kevin S. LaBar
- grid.26009.3d0000 0004 1936 7961Duke Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC USA ,Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham, NC USA
| | - Rajendra A. Morey
- grid.26009.3d0000 0004 1936 7961Duke Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC USA ,Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham, NC USA
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The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis. Clin Psychol Rev 2019; 73:101778. [PMID: 31678816 DOI: 10.1016/j.cpr.2019.101778] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 01/12/2023]
Abstract
Intolerance of uncertainty is a dispositional trait associated with a range of psychological disorders, but the influence of methodological factors on theses associations remains unknown. The first aim of this meta-analysis was to quantify the strengths of the association between IU and symptoms of generalised anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive compulsive disorder, depression, and eating disorders. The second aim was to assess the influence of methodological factors on these relationships, including clinical (vs. non-clinical) status, age group, sex, IU measure, and symptom measure. We extracted 181 studies (N participants = 52,402) reporting 335 independent effect sizes (Pearson's r). Overall, there was a moderate association between IU and symptoms (r = 0.51, 95% CI = 0.50-0.52), although heterogeneity was high (I2 = 83.50, p < .001). Some small but significant moderator effects emerged between and within disorders. Effect sizes were not impacted by sample size. The results indicate that IU has robust, moderate associations with a range of disorder symptoms, providing definitive evidence for the transdiagnostic nature of IU.
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32
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Martin RL, Bauer BW, Ramsey KL, Green BA, Capron DW, Anestis MD. How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample. Suicide Life Threat Behav 2019; 49:1318-1331. [PMID: 30368865 DOI: 10.1111/sltb.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the general suicide rate within the military being comparable to the general population when comparing peers, there are certain branches of the military that have elevated risk. Specifically, the U.S. National Guard has suicide rates that are constantly higher than other military branches and civilian peers. The National Guard are a unique military population in which they frequently transition between military and civilian life. With these unique experiences and heightened risk, military suicide prevention efforts may benefit from further research within this population. Posttraumatic stress disorder (PTSD) is another concern amongst military personnel and has been linked to suicidal behavior. METHODS The current study examined the indirect effects that distress tolerance, a protective factor against suicide, has on the relationship between PTSD and constructs within a well-validated theory for suicide (the Interpersonal-Psychological Theory for suicidal behaviors) in a sample of U.S. Army National Guard personnel. RESULTS Results indicated that distress tolerance had a significant indirect effect on the relationship between PTSD and thwarted belongingness, perceived burdensomeness, and capability for suicide. CONCLUSIONS These findings are consistent with previous literature examining the relationship between distress tolerance and our outcome variables. These results could have important clinical implications, mainly that intervention strategies targeting distress tolerance could have significant impacts on suicide-relate thoughts.
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Affiliation(s)
- Rachel L Martin
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Brian W Bauer
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kathleen L Ramsey
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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33
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Crabtree MA, Meyer EC, Kimbrel NA, DeBeer BB, Kruse MI, Gulliver SB, Telch M, Morissette SB. Factor Structure and Initial Validation of a Brief Measure of Perceived Emotional and Physical Distress Tolerance in Post-9/11 US Veterans. MILITARY PSYCHOLOGY 2019; 31:10.1080/08995605.2019.1637210. [PMID: 31660019 PMCID: PMC6816279 DOI: 10.1080/08995605.2019.1637210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/24/2019] [Indexed: 12/24/2022]
Abstract
Distress tolerance (i.e., perceived or actual capacity to tolerate aversive internal states) has received considerable research attention as a transdiagnostic risk-factor underlying the development and maintenance of psychopathology. Lower levels of emotional distress tolerance have been linked to psychopathology (e.g. Posttraumatic Stress Disorder) within Military populations; however, the association of physical distress tolerance to psychopathology in this population has been under-researched. This research gap may be due in part to a paucity of comprehensive, temporally stable and brief measures of distress tolerance that have been validated within Military populations, which may hinder further examination and refinement of the construct. Addressing this problem, the current study evaluates the psychometric properties of a novel and brief measure of emotional and physical distress tolerance in a sample of United States post-9/11 Veterans. Participants were 307 Veterans (Mage= 38.9, 67.7% male) who completed the 10-item Distress Tolerance Inventory at baseline and annual follow-up. Exploratory structural equation modeling was used to examine the optimal latent factor structure and longitudinal invariance of the DTI measurement model, along with correlational analyses to examine the convergent properties of the DTI subscales. The DTI reflected a longitudinally invariant two-factor structure (emotional and physical distress tolerance), with excellent internal consistency and preliminary evidence of convergent validity. Thus, the DTI represents a brief, reliable and temporally stable measure of physical and emotional distress tolerance.
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Affiliation(s)
| | - Eric C Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System
- Texas A&M University Health Science Center, College of Medicine
- Warriors Research Institute, Baylor Scott & White Health
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center
- Duke University School of Medicine
| | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System
- Warriors Research Institute, Baylor Scott & White Health
| | - Marc I Kruse
- Austin Fire Department & Austin-Travis County Emergency Medical Services
| | - Suzy B Gulliver
- Texas A&M University Health Science Center, College of Medicine
- Warriors Research Institute, Baylor Scott & White Health
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34
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Macatee RJ, Okey SA, Albanese BJ, Schmidt NB, Cougle JR. Distress intolerance moderation of motivated attention to cannabis and negative stimuli after induced stress among cannabis users: an ERP study. Addict Biol 2019; 24:717-729. [PMID: 29737034 DOI: 10.1111/adb.12622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/02/2018] [Accepted: 02/24/2018] [Indexed: 12/30/2022]
Abstract
Prevalence of cannabis use is increasing, but many regular users do not develop cannabis use disorder (CUD); thus, CUD risk identification among current users is vital for targeted intervention development. Existing data suggest that high distress intolerance (DI), an individual difference reflective of the ability to tolerate negative affect, may be linked to CUD, but no studies have tested possible neurophysiological mechanisms. Increased motivated attentional processing of cannabis and negative emotional stimuli as indexed by neurophysiology [i.e. the late positive potential (LPP)], particularly during acute stress, may contribute to CUD among high DI users. Frequent cannabis users with high (n = 61) and low DI (n = 44) viewed cannabis, negative, and matched neutral images during electroencephalography (EEG) recording before and after a laboratory stressor. Cannabis cue-elicited modulation of the 1000- to 3000-milliseconds LPP was larger in high DI users at post-stressor only, although the effect was only robust in the 1000- to 2000-milliseconds window. Further, modulation magnitude in the high DI group covaried with stress-relief craving and some CUD indices in the 400- to 1000-milliseconds and 1000- to 3000-milliseconds windows, respectively. No significant effects of DI on negative stimuli-elicited LPP modulation were found, although inverse associations with some CUD indices were observed. Finally, exploratory analyses revealed some evidence for DI moderation of the relation between subjective stressor reactivity and negative stimuli-elicited LPP modulation such that greater stressor reactivity was associated with blunted versus enhanced modulation in the high and low DI groups, respectively. Negative and cannabis stimuli-elicited LPP modulation appear to index distinct, CUD-relevant neural processes in high DI cannabis users.
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Affiliation(s)
| | - Sarah A. Okey
- Department of PsychologyArizona State University Tempe AZ USA
| | | | | | - Jesse R. Cougle
- Department of PsychologyFlorida State University Tallahassee FL USA
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35
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Raines AM, Oglesby ME, Walton JL, True G, Franklin CL. Intolerance of uncertainty and DSM-5 PTSD symptoms: Associations among a treatment seeking veteran sample. J Anxiety Disord 2019; 62:61-67. [PMID: 30572246 DOI: 10.1016/j.janxdis.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 12/17/2022]
Abstract
Intolerance of uncertainty (IU), defined as an inability to tolerate the unpleasant response triggered by the observed absence of information, has received increased empirical attention in recent years. The contribution of this cognitive behavioral construct to the etiology and maintenance of various anxiety disorders has become increasingly recognized. However, the relationship between IU and other affective disorders, including posttraumatic stress disorder (PTSD), remains largely unexplored. The current study sought to examine the relationship between IU and overall PTSD symptom and cluster severity using an outpatient sample of veterans (N = 116) assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) PTSD symptom structure. Results revealed that IU was significantly associated with overall PTSD symptom severity, above and beyond relevant covariates. Further, IU was significantly associated with the PTSD avoidance and hyperarousal clusters. Prospective IU, rather than inhibitory IU, accounted for these unique associations. These findings add to a growing body of literature establishing IU as a transdiagnostic risk factor and point to the importance of future research on the role of IU in contributing to and/or maintaining PTSD symptoms.
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Affiliation(s)
- Amanda M Raines
- South Central Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal St., New Orleans, LA, 70119, USA; Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA, 70119, USA.
| | - Mary E Oglesby
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA
| | - Jessica L Walton
- South Central Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal St., New Orleans, LA, 70119, USA; Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA, 70119, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA
| | - Gala True
- South Central Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal St., New Orleans, LA, 70119, USA; Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA, 70119, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA
| | - C Laurel Franklin
- South Central Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal St., New Orleans, LA, 70119, USA; Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA, 70119, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA
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36
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Macatee RJ, Albanese BJ, Clancy K, Allan NP, Bernat EM, Cougle JR, Schmidt NB. Distress intolerance modulation of neurophysiological markers of cognitive control during a complex go/no-go task. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 127:12-29. [PMID: 29369665 DOI: 10.1037/abn0000323] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Distress intolerance (DI), a trait-like individual difference reflective of the inability to endure aversive affective states, is relevant to multiple forms of psychopathology, but its relations to theoretically relevant neurobiological systems have received little attention. Altered cognitive control-related neurobiology has been theorized to underlie individual differences in DI, but little empirical work has been conducted. To test this hypothesis, baseline data from a large community sample with elevated high levels of emotional psychopathology and comorbidity was utilized (N = 256). Participants completed a complex go/no-go task while EEG was recorded, and P2, N2, and P3 amplitudes were measured. Based upon prior findings on the relations between these components and response inhibition, a core cognitive control function, we hypothesized that DI would predict reduced no-go N2 and P3 amplitude while controlling for current anxious/depressive symptom severity (i.e., negative affect). Peak amplitudes from the raw data and principal components analysis were used to quantify amplitude of ERP components. Partially consistent with predictions, high DI was independently associated with reduced no-go N2 peak amplitude in the raw ERP data, and was significantly related to a frontal positivity factor in the N2 time window across no-go and go trials. Contrary to predictions, no relations between DI and the P3 were found. Overall, results support the theorized relevance of cognitive control-linked neurobiology to individual differences in tolerance of distress over and above distress severity itself, and suggest specific relations between DI and alterations in early controlled attention/conflict-monitoring but not response inhibition or response inhibition-related sequelae. (PsycINFO Database Record
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Affiliation(s)
| | | | - Kevin Clancy
- Department of Psychology, Florida State University
| | | | - Edward M Bernat
- Department of Psychology, University of Maryland, College Park
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37
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Butt M, Espinal E, Aupperle RL, Nikulina V, Stewart JL. The Electrical Aftermath: Brain Signals of Posttraumatic Stress Disorder Filtered Through a Clinical Lens. Front Psychiatry 2019; 10:368. [PMID: 31214058 PMCID: PMC6555259 DOI: 10.3389/fpsyt.2019.00368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022] Open
Abstract
This review aims to identify patterns of electrical signals identified using electroencephalography (EEG) linked to posttraumatic stress disorder (PTSD) diagnosis and symptom dimensions. We filter EEG findings through a clinical lens, evaluating nuances in findings according to study criteria and participant characteristics. Within the EEG frequency domain, greater right than left parietal asymmetry in alpha band power is the most promising marker of PTSD symptoms and is linked to exaggerated physiological arousal that may impair filtering of environmental distractors. The most consistent findings within the EEG time domain focused on event related potentials (ERPs) include: 1) exaggerated frontocentral responses (contingent negative variation, mismatch negativity, and P3a amplitudes) to task-irrelevant distractors, and 2) attenuated parietal responses (P3b amplitudes) to task-relevant target stimuli. These findings suggest that some individuals with PTSD suffer from attention dysregulation, which could contribute to problems concentrating on daily tasks and goals in lieu of threatening distractors. Future research investigating the utility of alpha asymmetry and frontoparietal ERPs as diagnostic and predictive biomarkers or intervention targets are recommended.
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Affiliation(s)
- Mamona Butt
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Elizabeth Espinal
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | - Valentina Nikulina
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States.,Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
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38
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Vujanovic AA, Wardle MC, Bakhshaie J, Smith LJ, Green CE, Lane SD, Schmitz JM. Distress tolerance: Associations with trauma and substance cue reactivity in low-income, inner-city adults with substance use disorders and posttraumatic stress. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:264-276. [PMID: 29771557 DOI: 10.1037/adb0000362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cue reactivity has great potential to advance our understanding of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and PTSD/SUD comorbidity. The present investigation examined distress tolerance (DT) with regard to trauma and substance cue reactivity. Participants included 58 low-income, inner-city adults (49.1% women; Mage = 45.73, SD = 10.00) with substance dependence and at least 4 symptoms of PTSD. A script-driven cue reactivity paradigm was utilized. Four DT measures were administered, including the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath-Holding Task (BH), and Paced Auditory Serial Addition Task (PASAT). Lower DT, as indexed by MTPT duration, was significantly predictive of greater levels of self-reported substance cravings/urges in response to trauma cues, above and beyond covariates. Lower DTS scores predicted lower levels of self-reported control/safety ratings in response to substance cues. None of the DT indices was significantly predictive of heart rate variability. Clinical and research implications are discussed. (PsycINFO Database Record
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Affiliation(s)
| | - Margaret C Wardle
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | | | - Lia J Smith
- Department of Psychology, University of Houston
| | - Charles E Green
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Scott D Lane
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
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39
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Hollingsworth DW, Gauthier JM, McGuire AP, Peck KR, Hahn KS, Connolly KM. Intolerance of Uncertainty Mediates Symptoms of PTSD and Depression in African American Veterans With Comorbid PTSD and Substance Use Disorders. JOURNAL OF BLACK PSYCHOLOGY 2018. [DOI: 10.1177/0095798418809201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a major health concern among veterans, specifically African American veterans, and is commonly comorbid with other negative mental health outcomes including substance use disorders (SUD) and symptoms of depression. The current study examined intolerance of uncertainty as a mediator of the relationship between PTSD and depression symptoms in a sample of African American veterans with a dual diagnosis of PTSD and SUD. Participants included 113 African American veterans who were in treatment for PTSD and SUD at a Veterans Affairs Medical Center. Five mediation analyses were conducted to examine the mediational effect of intolerance of uncertainty on the relationship between PTSD symptom clusters (i.e., total, hyperarousal, numbness, avoidance, and intrusion) and depression symptoms. Findings indicated that intolerance of uncertainty mediated the relationship between four of the five mediation models (i.e., total symptoms, hyperarousal, numbness, and intrusion). These results imply that for African American veterans, higher levels of certain PTSD symptoms were associated with higher levels of intolerance of uncertainty, which in turn were related to increased levels of depression symptoms.
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Affiliation(s)
- David W. Hollingsworth
- Fairfield University, Fairfield, CT, USA
- University of Mississippi Medical Center, Jackson, MS, USA
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, MS, USA
| | - Jami M. Gauthier
- University of Mississippi Medical Center, Jackson, MS, USA
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, MS, USA
| | - Adam P. McGuire
- University of Mississippi Medical Center, Jackson, MS, USA
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, MS, USA
- Central Texas Health Care System, Waco, TX, USA
| | - Kelly R. Peck
- University of Mississippi Medical Center, Jackson, MS, USA
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, MS, USA
- University of Vermont, Burlington, VT, USA
| | | | - Kevin M. Connolly
- Alvin C. York Veterans Affairs Medical Center, Murfreesboro, TN, USA
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40
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Nicholson JR, Sommer B. The research domain criteria framework in drug discovery for neuropsychiatric diseases: focus on negative valence. Brain Neurosci Adv 2018; 2:2398212818804030. [PMID: 32166151 PMCID: PMC7058263 DOI: 10.1177/2398212818804030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/24/2018] [Indexed: 12/22/2022] Open
Abstract
Drug discovery, particularly in the field of central nervous system, has had very limited success in the last few decades. A likely contributor is the poor translation between preclinical and clinical phases. The Research Domain Criteria of the National Institutes of Mental Health is a framework which aims to identify new ways of classifying mental illnesses that are based on observable behaviour and neurobiological measures, and to provide a guiding and evolving framework to improve the translation from preclinical to clinical research. At the core of the Research Domain Criteria approach is the assumption that the dimensional constructs described can be assessed across different units of analysis, thus enabling a more precise quantitative understanding of their neurobiological underpinnings, increasing the likelihood of identifying new and effective therapeutic approaches. In the present review, we discuss how the Research Domain Criteria can be applied to drug discovery with the domain Negative Valence, construct Potential Threat (‘Anxiety’) as an example. We will discuss the evidence supporting the utility of the Research Domain Criteria approach and evaluate how close we are to achieving a common thread of translational research from gene to self-report.
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Affiliation(s)
- Janet R Nicholson
- CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Bernd Sommer
- CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
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41
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Overstreet C, Brown E, Berenz EC, Brown RC, Hawn S, McDonald S, Pickett T, Danielson CK, Thomas S, Amstadter A. Anxiety Sensitivity and Distress Tolerance Typologies and Relations to Posttraumatic Stress Disorder: A Cluster Analytic Approach. MILITARY PSYCHOLOGY 2018; 30:547-556. [PMID: 30886457 DOI: 10.1080/08995605.2018.1521682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A growing literature suggests a relationship between a high anxiety sensitivity (AS; the fear of anxiety and its related consequences)/low distress tolerance (DT; the capacity tolerate internal negative states) profile and posttraumatic stress disorder (PTSD) symptoms. However, specific profiles have not been identified or examined specifically in veteran samples. Thus, the aims of the present study were to establish empirically derived profiles created from response patterns on the Anxiety Sensitivity Index and Distress Tolerance Scale and to examine associations with PTSD symptom clusters among a sample of combat-exposed veterans (N = 250). A cluster analytic approach was utilized to identify AS/DT profiles, and a series of MANOVAs with post hoc analyses was conducted to examine the relationship between each AS/DT profile and each PTSD symptom cluster. Results indicated a three-cluster solution including a high AS/low DT "at risk" profile, a low AS/high DT "resilient" profile, and an average AS/DT "intermediate" profile. The at-risk profile was associated with significantly greater symptoms in each PTSD cluster (i.e., hyperarousal, avoidance, re-experiencing) when compared to the other two profiles. The at-risk profile was also associated with greater depressive symptoms and lower self-reported resilience. These findings extend the previous literature by identifying a high AS/low DT "at risk" profile and its associations with PTSD symptoms, underscoring the potential utility in targeting these affect-regulation constructs for clinical intervention.
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Affiliation(s)
- Cassie Overstreet
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Emily Brown
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Erin C Berenz
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.,Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ruth C Brown
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Sage Hawn
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Suzanne Thomas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ananda Amstadter
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Boffa JW, Short NA, Gibby BA, Stentz LA, Schmidt NB. Distress tolerance as a mechanism of PTSD symptom change: Evidence for mediation in a treatment-seeking sample. Psychiatry Res 2018; 267:400-408. [PMID: 29960937 PMCID: PMC6434692 DOI: 10.1016/j.psychres.2018.03.085] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
Abstract
Low distress tolerance, the perceived or actual inability to tolerate negative emotional states, is a transdiagnostic risk marker associated with greater PTSD symptoms and poorer treatment outcomes. However, the role of distress tolerance in PTSD symptom trajectories has not yet been explored. This study examined the mediating role of distress tolerance in PTSD symptom change among outpatients participating in a trial of computerized interventions for anxiety-related and mood-related risk factors. It was hypothesized that pre- to post-intervention change in distress tolerance would predict PTSD symptoms at three- and six-month follow-up, and mediate the effect of condition on PTSD symptoms above and beyond the effects of a competing mediator, anxiety sensitivity. Although condition differences in distress tolerance change were non-significant, distress tolerance change predicted month-three PTSD symptoms and mediated the direct effect of condition on month-three PTSD symptoms. After accounting for the direct effect of condition on month-six PTSD symptoms, distress tolerance change did not predict month-six PTSD symptoms. Findings suggest distress tolerance does play a longitudinal role in PTSD symptom change, and distress tolerance interventions may benefit certain samples who may otherwise not be able to immediately access, or remain in PTSD treatments.
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Affiliation(s)
| | | | | | | | - Norman B. Schmidt
- Correspondence concerning this article should be addressed to Norman B. Schmidt, Department of Psychology, Florida State University, Tallahassee, FL, 32306. ; Telephone: (850) 644-1707; Fax: (850) 644-1707
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43
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Levy HC, Wanklyn SG, Voluse AC, Connolly KM. Distress tolerance but not impulsivity predicts outcome in concurrent treatment for posttraumatic stress disorder and substance use disorder. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hannah C. Levy
- G. V. (Sonny) Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut
| | - Sonya G. Wanklyn
- G. V. (Sonny) Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew C. Voluse
- G. V. (Sonny) Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kevin M. Connolly
- G. V. (Sonny) Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi
- Alvin C. York VA Medical Center, Murfreesboro, Tennessee
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44
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Investigating the latent structure of distress intolerance. Psychiatry Res 2018; 262:513-519. [PMID: 28951144 DOI: 10.1016/j.psychres.2017.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/07/2017] [Accepted: 09/12/2017] [Indexed: 11/22/2022]
Abstract
Distress intolerance (DI) is defined as a perceived or actual inability to withstand distressing emotional or somatic states, which motivates the use of avoidance strategies. Despite widespread interest in DI, key questions about its underlying structure remain unanswered. The current study evaluated the latent structure of DI in two large samples using four-indicators and three taxometric procedures (MAMBAC, MAXEIG, and L-Mode). Data interpretation relied primarily on the Comparison Curve Fit Indices (CCFI). Overall, results from the three non-redundant procedures suggested that DI was more accurately characterized by a dimensional rather than a categorical conceptualization. Implications for assessment and conceptual models of DI are discussed.
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45
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Vujanovic AA, Smith LJ, Green CE, Lane SD, Schmitz JM. Development of a novel, integrated cognitive-behavioral therapy for co-occurring posttraumatic stress and substance use disorders: A pilot randomized clinical trial. Contemp Clin Trials 2018; 65:123-129. [PMID: 29287668 PMCID: PMC5803416 DOI: 10.1016/j.cct.2017.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/23/2017] [Accepted: 12/24/2017] [Indexed: 01/11/2023]
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. The present pilot randomized clinical trial was designed to evaluate the feasibility and preliminary efficacy of a novel, integrated cognitive-behavioral treatment approach for PTSD/SUD, entitled Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS), as compared to standard cognitive-behavioral treatment (CBT) for SUD. The TIPSS program integrates cognitive processing therapy with CBT for SUD for the treatment of co-occurring PTSD/SUD. Both treatment conditions are comprised of 12, 60-minute individual psychotherapy sessions, delivered twice-weekly over six weeks. Primary aims examine whether TIPSS, compared to standard CBT for SUD, reduces: (1) PTSD symptoms and (2) substance use outcomes (i.e., self-report, objective). Secondary aims examine whether (a) trauma- and substance cue reactivity and (b) distress tolerance (i.e., actual or perceived ability to withstand uncomfortable emotional or physical states) are significant mechanisms of change. The study was recently closed to new enrollment. Participants included adults with substance dependence and at least four symptoms of PTSD.
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Affiliation(s)
| | - Lia J Smith
- Department of Psychology, University of Houston, United States
| | - Charles E Green
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, United States
| | - Scott D Lane
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, United States
| | - Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, United States
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46
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Banducci AN, Lejuez CW, Dougherty LR, MacPherson L. A Prospective Examination of the Relations Between Emotional Abuse and Anxiety: Moderation by Distress Tolerance. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 18:20-30. [PMID: 27501698 DOI: 10.1007/s11121-016-0691-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anxiety, the most common and impairing psychological problem experienced by youth, is associated with numerous individual and environmental factors. Two such factors include childhood emotional abuse (CEA) and low distress tolerance (DT). The current study aimed to understand how CEA and low DT impacted anxiety symptoms measured annually across 5 years among a community sample of youth. We hypothesized DT would moderate the relationship between CEA and anxiety, such that youth with higher levels of CEA and lower levels of DT would have elevated anxiety over time. Community youth (N = 244) were annually assessed across 5 years using the Revised Child Anxiety and Depression Scale, Childhood Trauma Questionnaire, and Behavioral Indicator of Resiliency to Distress. Higher CEA at baseline was associated with higher anxiety at baseline, higher anxiety at each annual assessment, and with greater overall decreases in anxiety over time. Lower DT was associated with higher anxiety at baseline, but did not predict changes in anxiety over time. Baseline DT significantly moderated the relationship between baseline CEA and anxiety, such that youth with both higher CEA and lower DT had the highest anxiety at each annual assessment. Youth with lower DT and higher CEA scores had the highest level of anxiety symptoms across time.
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Affiliation(s)
- Anne N Banducci
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (NCPTSD 324), Menlo Park, CA, 94025, USA. .,Department of Psychology, University of Maryland, 1147 Biology Psychology Building, College Park, MD, 20742, USA. .,Center for Addictions, Personality, and Emotion Research, University of Maryland, 2103 Cole Student Activities Building, College Park, MD, 20742, USA.
| | - C W Lejuez
- Department of Psychology, University of Maryland, 1147 Biology Psychology Building, College Park, MD, 20742, USA.,Center for Addictions, Personality, and Emotion Research, University of Maryland, 2103 Cole Student Activities Building, College Park, MD, 20742, USA.,College of Liberal Arts & Sciences, The University of Kansas, Strong Hall, Room 200, 1450 Jayhawk Blvd., Lawrence, KS, 66049, USA
| | - Lea R Dougherty
- Department of Psychology, University of Maryland, 1147 Biology Psychology Building, College Park, MD, 20742, USA
| | - Laura MacPherson
- Department of Psychology, University of Maryland, 1147 Biology Psychology Building, College Park, MD, 20742, USA.,Center for Addictions, Personality, and Emotion Research, University of Maryland, 2103 Cole Student Activities Building, College Park, MD, 20742, USA
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Szafranski DD, Snead A, Allan NP, Gros DF, Killeen T, Flanagan J, Pericot-Valverde I, Back SE. Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout. Addict Behav 2017; 73:30-35. [PMID: 28460246 DOI: 10.1016/j.addbeh.2017.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 01/09/2023]
Abstract
High rates of comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) have been noted in veteran populations. Fortunately, there are a number of evidence-based psychotherapies designed to address comorbid PTSD and SUD. However, treatments targeting PTSD and SUD simultaneously often report high dropout rates. To date, only one study has examined predictors of dropout from PTSD/SUD treatment. To address this gap in the literature, this study aimed to 1) examine when in the course of treatment dropout occurred, and 2) identify predictors of dropout from a concurrent treatment for PTSD and SUD. Participants were 51 male and female veterans diagnosed with current PTSD and SUD. All participants completed at least one session of a cognitive-behavioral treatment (COPE) designed to simultaneously address PTSD and SUD symptoms. Of the 51 participants, 22 (43.1%) dropped out of treatment prior to completing the full 12 session COPE protocol. Results indicated that the majority of dropout (55%) occurred after session 6, with the largest amount of dropout occurring between sessions 9 and 10. Results also indicated a marginally significant relationship between greater baseline PTSD symptom severity and premature dropout. These findings highlight inconsistencies related to timing and predictors of dropout, as well as the dearth of information noted about treatment dropout within PTSD and SUD literature. Suggestions for procedural changes, such as implementing continual symptom assessments during treatment and increasing dialog between provider and patient about dropout were made with the hopes of increasing consistency of findings and eventually reducing treatment dropout.
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Katz D, Rector NA, Laposa JM. The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder. Cogn Behav Ther 2017. [DOI: 10.1080/16506073.2017.1334087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Danielle Katz
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil A. Rector
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Judith M. Laposa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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49
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Vujanovic AA, Dutcher CD, Berenz EC. Multimodal examination of distress tolerance and posttraumatic stress disorder symptoms in acute-care psychiatric inpatients. J Anxiety Disord 2017; 48:45-53. [PMID: 27605231 DOI: 10.1016/j.janxdis.2016.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
Distress tolerance (DT), the actual or perceived capacity to withstand negative internal states, has received increasing scholarly attention due to its theoretical and clinical relevance to posttraumatic stress disorder (PTSD). Past studies have indicated that lower self-reported - but not behaviorally observed - DT is associated with greater PTSD symptoms; however, studies in racially and socioeconomically diverse clinical samples are lacking. The current study evaluated associations between multiple measures of DT (self-report and behavioral) and PTSD symptoms in an urban, racially and socioeconomically diverse, acute-care psychiatric inpatient sample. It was hypothesized that lower self-reported DT (Distress Tolerance Scale [DTS]), but not behavioral DT (breath-holding task [BH]; mirror-tracing persistence task [MT]), would be associated with greater PTSD symptoms, above and beyond the variance contributed by trauma load, substance use, gender, race/ethnicity, and subjective social status. Participants were 103 (41.7% women, Mage=33.5) acute-care psychiatric inpatients who endorsed exposure to potentially traumatic events consistent with DSM-5 PTSD Criterion A. Results of hierarchical regression analyses indicated that DTS was negatively associated with PTSD symptom severity (PCL-5 Total) as well as with each of the four DSM-5 PTSD symptom clusters (p's<0.001), contributing between 5.0%-11.1% of unique variance in PTSD symptoms across models. BH duration was positively associated with PTSD arousal symptom severity (p<0.05). Covariates contributed between 21.3%-40.0% of significant variance to the models. Associations between DT and PTSD in this sample of acute-care psychiatric inpatients are largely consistent with those observed in community samples.
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50
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Psychological and behavioral moderators of the relationship between trauma severity and HIV transmission risk behavior among MSM with a history of childhood sexual abuse. J Behav Med 2017; 40:794-802. [PMID: 28396969 DOI: 10.1007/s10865-017-9848-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Childhood sexual abuse (CSA) is associated with post-traumatic stress disorder (PTSD), which can be associated with condomless sex among men who have sex with men (MSM). However, the impact of moderating factors on the relationship between PTSD symptom severity and condomless sex is poorly understood. We examined whether PTSD symptom severity was associated with condomless sex among MSM with CSA histories, and whether substance dependence, self-esteem, and distress tolerance moderated that relationship (n = 288). Notably, no direct relationship between PTSD symptom severity and condomless sex was found. Adjusted models indicated that condomless sex was differentially impacted by PTSD symptom severity among those without substance dependence (ΔR2 = 0.03, p = 0.034) and, counterintuitively, those with high self-esteem (ΔR2 = 0.07, p = 0.005). PTSD symptom severity was associated with condomless sex across levels of distress tolerance. Findings indicate that substance use, self-esteem, and distress tolerance should be targeted in high-risk MSM with CSA even if they do not have PTSD.
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