Refinement of anxiety sensitivity measurement: The Short Scale Anxiety Sensitivity Index (SSASI)

Anxiety sensitivity in relation to smoking dependence motives among Latinx persons who smoke

Hispanic/Latinx (hereafter Latinx) persons are an established tobacco disparities population in the United States (US). Past work has suggested that individual differences in anxiety sensitivity, or the fear of arousal-based sensations, is one important cognitive construct for smoking maintenance and relapse among Latinx persons who smoke. However, previous research has not examined if anxiety sensitivity is associated with motivational facets of smoking dependence among this tobacco disparities population. In the current study, anxiety sensitivity was explored in terms of smoking motives for primary, secondary, and overall cigarette dependence. Participants included 336 English-speaking Latinx adults in the US who smoked cigarettes daily (Mage = 35.53, SD = 8.65, 37.3% Female). Results indicated that anxiety sensitivity was statistically significantly and positively related to higher primary and secondary dependence motives and marginally statistically significant to cigarette dependence; findings were evident after adjusting for numerous theoretically relevant variables (e.g., depression). Overall, the current study is the first to document linkages between anxiety sensitivity and numerous motivational bases of tobacco dependence among Latinx persons who smoke from the US.

Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity (STEP): Study protocol for a randomized controlled trial

Anxiety sensitivity (AS), reflecting the fear of bodily sensations, is a transdiagnostic vulnerability factor that underpins both affective psychopathology and smoking. Phase II research supports the efficacy of a 15-week community-based intervention (STEP) that combines high-intensity exercise offered by the YMCA with standard smoking cessation treatment (tobacco quitline and nicotine replacement therapy) for sedentary smokers with elevated AS. This Phase III study aims to enroll 360 adults to evaluate whether STEP efficacy for achieving smoking abstinence generalizes to Black and Hispanic smokers with elevated AS.

An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial

BACKGROUND

Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV.

OBJECTIVE

This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management.

METHODS

This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute's QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date).

RESULTS

Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy.

CONCLUSIONS

The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52090.

Predictors of negative moral appraisals and their association with symptoms of post-traumatic stress and depression in the context of COVID-19 related stressors

Research on moral injury (MI) suggests that negative moral appraisals of stressful events can impact mental health in high-stakes occupational contexts (e.g., military). Few studies have examined these associations in the general population, limiting the generalisability of findings. Furthermore, factors that may predispose an individual to adverse outcomes in the context of moral stressors remain largely unknown. The objectives of this study were to (1) explore the applicability of the MI construct to stressors experienced by the general public during the COVID-19 pandemic; (2) explore how trait differences in sense of duty, religiosity/spirituality, anxiety sensitivity, and guilt, shame, and anger, predict negative moral appraisals of COVID-19 stressors. Participants (n = 355) completed an online survey assessing exposure to and appraisals of COVID-19 stressors, mental health symptoms, and dispositional characteristics (i.e., trait emotions, anxiety sensitivity, sense of duty, religiosity/spirituality). Path analysis revealed specific indirect associations between self-based moral appraisals and posttraumatic stress disorder (PTSD) and depression through guilt, and between both self- and other-based moral appraisals and PTSD and depression through anger. Number of COVID-19 stressors had no influence on associations. Sense of duty, reparative guilt, and anxiety sensitivity best predicted negative moral appraisals. Findings partially support the applicability of the MI construct outside the occupational context.

Psychometric Properties of the Short Scale Anxiety Sensitivity Index Among Adults with Chronic Respiratory Disease

Approximately one-third of adults with chronic respiratory disease (CRD) have comorbid depressive and anxiety disorders; yet these disorders are often unrecognized in this patient population. Transdiagnostic processes such as anxiety sensitivity (AS) are useful for identifying mechanisms underlying psychological and heath conditions. The Short-Scale AS Index (SSASI) is a brief self-report measure of AS which has potential clinical utility among CRD populations to evaluate psychological distress and inform comprehensive care. The present study investigated the psychometric properties of the SSASI among adults with CRDs. Participants were recruited from a web-based panel of adults with CRDs (n = 768; 49.3% female; 57.8% White) including adults with asthma only (n = 230), COPD only (n = 321), or co-occurring asthma and COPD (n = 217). Participants completed a battery of self-report questionnaires assessing psychological and medical symptoms. Analyses were conducted to examine the factor structure and measurement invariance across CRD groups. Convergent validity and criterion validity of the SSASI were assessed within each group. Results supported partial measurement invariance across CRD groups. The SSASI demonstrated high reliability, convergent validity, and criterion validity with each CRD group. Findings from this study and existing work indicate that the SSASI is an effective and economical assessment tool for identifying patients CRD who may benefit from psychological interventions to reduce AS.

Anxiety sensitivity in terms of mental health among a racially and ethnically diverse sample of sexual minority college students

Objective: Limited work has focused on understanding the function of individual difference factors in terms of mental health among sexual minority college students. Anxiety sensitivity is one individual difference factor which has received substantial empirical attention, but its role is presently understudied among racially/ethnically diverse sexual minority college students.Participants: Participants included a racially and ethnically diverse sample of sexual minority college students (N = 217; Mage = 20.82 years; SD = 3.06).Methods: The present investigation evaluated the role of anxiety sensitivity in relation to anxious arousal, social anxiety, depression, and suicidality.Results: Results indicated that anxiety sensitivity was significantly related to increased anxious arousal, social anxiety, depression, and suicidality after adjusting for age, sex, relationship status, subjective social status, and neuroticism.Conclusions: This investigation provides the first empirical evidence that anxiety sensitivity is related to poorer mental health outcomes for racially/ethnically diverse sexual minority college students.

Role of perceived discrimination and anxiety sensitivity in cigarette smoking among english-speaking latinx adults living in the United States

OBJECTIVE

The Latinx/Hispanic (hereafter, Latinx) population in the United States (US) experiences significant tobacco-related health disparities. Extant work suggests social determinants of health (SDoH) such as perceived discrimination is an individual differences factor for cigarette smoking behavior among Latinx individuals who smoke cigarettes. Other research has suggested sensitivity to internal cues, referred to as anxiety sensitivity, is related to smoking among Latinx adults, but this work has not explored whether anxiety sensitivity may moderate the association between perceived discrimination and smoking behavior.

METHOD

Therefore, the present investigation sought to explore the main and interactive association of perceived discrimination and anxiety sensitivity in relation to cigarettes smoked per day, severity of problems experienced when quitting, and perceived barriers for smoking cessation among 338 English-speaking Latinx individuals living in the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female) who smoke cigarettes.

RESULTS

Results supported statistically significant main effects for perceived discrimination and anxiety sensitivity in relation to increased severity of problems experienced when quitting and perceived barriers for smoking cessation. These associations were evident after adjusting for a sociodemographic covariates.

CONCLUSION

Overall, the present investigation suggests that both perceived discrimination and anxiety sensitivity are important constructs relevant to understanding smoking processes among Latinx adults who smoke cigarettes and should be integrated in theoretical models of smoking among this population.

Anxiety-related constructs and smoking outcome expectancies among Latinx smokers

Hispanic/Latinx (hereafter Latinx) smokers in the United States (US) experience unique smoking cessation-related challenges. Smoking outcome expectancies (i.e., positive and negative beliefs about the consequences of smoking behavior) have been linked to the maintenance of smoking and comorbidity with negative emotional states such as anxiety among Latinx smokers. However, past work has not characterized rates of probable anxiety disorder and elevated levels of anxiety sensitivity among English-speaking daily Latinx smokers from the United States or concurrently evaluated the explanatory relevance of anxiety symptoms and anxiety sensitivity for negative and positive smoking outcome expectancies. The present investigation sought to (a) determine the base rate of probable anxiety disorder and elevated anxiety sensitivity and (b) explore the unique roles of anxiety symptoms and anxiety sensitivity in relation to negative and positive smoking outcome expectancies. Participants included 338 English-speaking Latinx adult daily cigarette smokers from the United States (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Findings revealed high rates of probable anxiety disorder (50.9%) and elevated anxiety sensitivity (73.4%) among English-speaking Latinx smokers from the United States. Anxiety sensitivity, but not anxiety symptoms or disorders, was significantly related to negative consequences, negative reinforcement, positive reinforcement, and appetite/weight control smoking outcome expectancies. Overall, anxiety experiences were common among Latinx smokers, and anxiety sensitivity was a relatively more consistent and robust predictor of negative and positive outcome expectancies relative to anxiety symptoms and probable anxiety disorder. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Anxiety Sensitivity Among Trauma-Exposed Non-Hispanic Black Adults: Relations to Posttraumatic Stress

ABSTRACT

The non-Hispanic Black population experiences trauma-related disparities. One potentially important individual difference construct for posttraumatic stress is anxiety sensitivity. There is limited work on anxiety sensitivity among non-Hispanic Black persons, and no research has focused on this construct in terms of posttraumatic stress among this population. This study sought to build on this limited knowledge by exploring whether this construct was uniquely associated with more severe posttraumatic stress among this population. Participants included non-Hispanic Black trauma-exposed adults ( N = 121; Mage = 21.79 years). Results indicated that anxiety sensitivity was related to more severe overall posttraumatic stress and greater severity of each posttraumatic stress symptom cluster; all effects were evident after adjusting for the variance accounted for by age, sex, education, subjective social status, neuroticism, and number of traumatic event types experienced (lifetime). The study provides the first empirical evidence that, among a trauma-exposed non-Hispanic Black sample of adults, anxiety sensitivity is related to more severe posttraumatic stress symptoms. This intraindividual difference factor could be a focus of intervention programming for this trauma disparity population.

Anxiety Sensitivity Among Non-Hispanic Black Adults: Relations to Mental Health and Psychosomatic States

The non-Hispanic Black adult population has notable disparities in mental and physical health compared to several other racial/ethnic groups. Yet, there is a lack of scientific knowledge about psychologically based individual difference factors that may be associated with an exacerbation of common mental and physical health symptoms among non-Hispanic Black persons. The present investigation sought to build on the limited knowledge about anxiety sensitivity among non-Hispanic Black adults by exploring whether this construct was uniquely associated with a range of prevalent mental health and psychosomatic symptoms commonly tied to disparities among this population. Participants included non-Hispanic Black adults (N = 205; Mage = 21.67 years; SDage = 5.39; age range: 18-60 years; 82.0% female). Results indicated that anxiety sensitivity was positively related to anxious arousal, general depression, insomnia, fatigue severity, and somatic symptom severity; effects were evident above and beyond the variance explained by a range of covariates, including age, sex, education, subjective social status, and neuroticism. Overall, the present findings uniquely build from past research on anxiety sensitivity and non-Hispanic Black adults by demonstrating that individual differences in this construct are consistently and relatively robustly associated with a wide range of mental health and psychosomatic symptoms. Future research that builds from this work may benefit from consideration of intervention programming targeting anxiety sensitivity reduction to offset mental and physical health impairments among the non-Hispanic Black population.

Transdiagnostic Processes Linking Posttraumatic Stress Disorder Symptoms to Alcohol Use Severity

Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.

Evaluation of an integrated personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity and PTSD symptoms: Protocol for a randomized controlled trial

Background

Hazardous drinking and posttraumatic stress disorder (PTSD) are commonly co-occurring conditions among adults. Motivational enhancement interventions, such as personalized feedback interventions (PFI), have demonstrated efficacy for reducing hazardous drinking. Emerging though scant literature has evaluated PFI for co-occurring PTSD and hazardous alcohol use. A transdiagnostic risk factor that may underlie this co-occurrence and inform novel PFI development is anxiety sensitivity (AS).

Objective

To use a randomized controlled trial to evaluate the efficacy of a novel, computer-based PFI for hazardous drinkers with at least subclinical PTSD and elevated AS (AP-PFI), against a time-matched comparison condition (C-PFI).

Methods

Participants (N = 100) will be recruited and enrolled from the Houston, TX community. The study includes: an in-person visit (baseline diagnostic assessment, a brief intervention, and a post-intervention assessment) and two follow-up assessments (1-week and 1-month). Participants who meet study inclusion criteria will be randomized to one of two conditions at baseline: AP-PFI or C-PFI. AP-PFI will consist of a brief, single-session, computer-delivered, PFI-based intervention that provides integrative and normative feedback about alcohol use, AS, and PTSD symptoms. C-PFI will be time-matched but will only include alcohol-related feedback.

Conclusions

AP-PFI is designed to provide feedback about alcohol use, PTSD symptoms, and AS and their interplay and deliver psychoeducation on harm-reduction techniques, interoceptive exposure exercises, and stress management strategies. The intervention may address extant gaps in treatment for these co-occurring conditions by providing a brief, evidence-based, motivational enhancement intervention that is cost-effective with potential to be disseminated across a variety of healthcare settings.

Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers

Cigarette smoking is associated with adverse physical and mental health among Latinx adults in the United States. The present investigation sought to explore the main and interactive effects of anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation, and severity of problems experienced when quitting among adult Latinx smokers. Participants included 338 Latinx adult daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that anxiety symptoms were associated with greater cigarette dependence, severity of problems when quitting, and perceived barriers for smoking cessation (effect size range: 2%-3% of variance), whereas anxiety sensitivity was related to severity of problems when quitting and perceived barriers for smoking cessation (effect size range: 2%-3% of variance). There was also a statistically significant interaction between anxiety sensitivity and anxiety symptoms for cigarette dependence; anxiety was related to cigarette dependence for Latinx smokers with higher levels of anxiety sensitivity, but not for those with lower levels of anxiety sensitivity. Overall, the present findings indicate that anxiety symptoms and anxiety sensitivity are relevant factors for better understanding cigarette dependence, problems experienced when trying to quit, and perceptions of barriers to quitting among adult Latinx smokers.

Brief adjunctive mindfulness-based cognitive therapy via Telehealth for anxiety during the COVID-19 pandemic

BACKGROUND AND OBJECTIVES

While cognitive-behavioral therapy is a highly efficacious treatment for anxiety, additional research is needed to identify adjunctive interventions that may augment treatment outcome.

DESIGN

In response to the COVID-19 pandemic, we conducted an open feasibility trial of brief (i.e., four 75- to 90-minute sessions) mindfulness-based cognitive therapy (MBCT) for anxiety via telehealth for patients (N = 23) receiving individual CBT at an outpatient specialty clinic.

METHODS

Self-report measures of home practice compliance (weekly), intervention acceptability (post-intervention), mindfulness and self-compassion, anxiety and depressive symptoms, and transdiagnostic processes (pre- and post-intervention) were administered as part of routine clinical practice.

RESULTS

Results indicated good retention and attendance rates, few technical difficulties, good home practice compliance, and high levels of perceived importance. Participants indicated that they would highly recommend the group to others and also recommended extending the group beyond four sessions. There were significant improvements in mindfulness and self-compassion and reductions in intolerance of uncertainty, anxiety sensitivity, distress intolerance, emotion dysregulation, and anxiety symptoms from pre- to post-intervention.

CONCLUSIONS

Brief MBCT as an adjunctive treatment for anxiety via telehealth is feasible and acceptable, and shows promise in terms of engaging treatment targets and transdiagnostic processes and reducing anxiety symptoms.

A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial

BACKGROUND

Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic.

OBJECTIVE

This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both.

METHODS

The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care.

RESULTS

Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19-specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data.

CONCLUSIONS

Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40713.

Anxiety sensitivity in relation to post-traumatic stress disorder symptom clusters among young adults with probable post-traumatic stress disorder

Despite the promise of past research on anxiety sensitivity (AS) and posttraumatic stress, extant work is limited, given (1) most studies consist of non-Hispanic White and middle-aged samples, (2) few have demonstrated incremental validity to general emotional traits and social determinants of health, and (3) limited work has characterized how AS relates to specific Posttraumatic Stress Disorder (PTSD) symptom clusters among those with (probable) PTSD. The current study evaluated the role of AS in relation to PTSD symptom clusters among a racially/ethnically diverse sample of young adults with probable PTSD. Participants included young adults who met the clinical cut-off for probable PTSD per the Posttraumatic Diagnostic Scale. Results indicated that AS was significantly related to overall posttraumatic stress symptom severity; the effect was evident after adjusting for a range of covariates including neuroticism and subjective social status. AS also was incrementally associated with arousal and hyperreactivity, changes in mood and cognition, and intrusion PTSD symptom clusters. In contrast to expectation, no effect for AS was evident for the avoidance PTSD symptom cluster. The current data uniquely add to the existing AS PTSD literature by showcasing distinct symptom cluster patterns among a racially/ethnically diverse sample of young adults with probable PTSD.

The association between race- and ethnicity-related stressors and sleep: the role of rumination and anxiety sensitivity

STUDY OBJECTIVES

This study was designed to investigate the association between psychosocial factors and self-reported sleep duration and two indices of sleep quality in a racially and ethnically diverse sample of adults. We investigated the relations between both rumination and anxiety sensitivity with these self-reported sleep outcomes. We also examined rumination and anxiety sensitivity as moderators of three race- and ethnicity-related stressors: discrimination, acculturative stress, and socioeconomic status.

METHODS

In a cross-sectional design, we assessed 1326 adults (ages 18-48 years) selected for self-reported racial and ethnic minority status. Regression analyses were used to examine the associations between demographic, social/environmental stressors, depression severity, rumination, and anxiety sensitivity and three sleep outcomes: sleep duration, sleep quality subscale, and global sleep quality.

RESULTS

Our findings supported the hypothesized role of rumination as an amplification factor for the influence of race- and ethnicity-related stressors on sleep duration and quality. Rumination was associated with all three sleep outcomes (sleep duration, sleep quality subscale, and global sleep quality) and was a moderator of the associations between discrimination and all 3 sleep outcomes. Anxiety sensitivity was not consistently associated with these sleep outcomes. Depression symptoms did not account for these findings.

CONCLUSIONS

If confirmed in longitudinal study, our findings introduce a potentially important treatment target-rumination-for addressing sleep disparities in prevention or intervention models. Rumination appears to amplify the negative sleep consequences of race- and ethnicity-related stressors and is a modifiable treatment target.

Anxiety sensitivity and its association with perceived barriers for quitting, smoking inflexibility, and severity of quit problems among Black smokers

Black individuals who smoke in the United States experience health disparities related to tobacco use (e.g., greater nicotine dependence, less success in quitting smoking) and interoceptive distress (e.g., somatic symptoms, anxiety). Individual difference factors that amplify interoceptive distress and contribute to poorer smoking behaviors and outcomes warrant further attention and investigation. Thus, the present study sought to explore the association between anxiety sensitivity and clinically-relevant smoking variables of perceived barriers for quitting, smoking inflexibility, and problems experienced during past quit attempts. Participants in the current study included 98 Black adult smokers (71.4% male; Mage = 44.08 years, SD = 11.44 years). Results indicated greater levels of anxiety sensitivity were associated with greater levels of perceived barriers for quitting smoking (b = 0.10, SE = 0.08, p = 0.01), smoking inflexibility (b = 0.02, SE <.001, p <.001), and problems experienced during past smoking quit attempts (b = 0.17, SE = 0.07, p = 0.02). Clinical implications and future directions are further discussed as it relates to anxiety sensitivity and efforts to reduce or quit smoking for this health disparities population.

Changes in Internalizing Symptoms and Anxiety Sensitivity Among College Students During the COVID-19 Pandemic

The early months of the COVID-19 pandemic saw significant increases in symptoms of anxiety and depression, particularly among college students. However, research has not examined how internalizing symptoms in this population have changed as the pandemic has continued into its second year. Further, there has yet to be an examination of potential changes in transdiagnostic vulnerability factors. Therefore, the purpose of the current repeated cross-sectional study was to examine differences by term in undergraduates’ symptoms of depression, anxiety, worry, social anxiety, and anxiety sensitivity in the Spring 2020 (n = 251), Fall 2020 (n = 427), and Spring 2021 (n = 256) semesters. Results indicated that there were significant increases in depression, anxiety, worry, and anxiety sensitivity from Spring 2020 to Fall 2020 that were maintained through the Spring 2021 semester, and levels of social anxiety were significantly higher in Spring 2021 compared to Spring 2020. These findings suggest that the mental health impacts of the COVID-19 pandemic on college students have continued beyond the initial months, and colleges and universities will need to develop comprehensive plans to adequately address college students’ mental health needs.

Impact of cannabidiol-rich hemp extract oil on reconsolidation disruption of naturalistic interoceptive aversive memory in humans: Protocol for a randomized clinical trial

BACKGROUND

Preclinical experiments with rodents demonstrate that cannabidiol (CBD), the non-psychotomimetic constituent of the Cannabis sativa plant, disrupts reconsolidation of aversive memories conditioned in the laboratory when administered within the memory reconsolidation window (< 6 h. post-retrieval) by indirectly activating cannabinoid type-1 (CB₁) receptors in the dorsal anterior cingulate cortex (dACC). Based on these findings, we aim to test whether administration of 300 mg CBD-rich hemp extract oil following fear reactivation of an aversive interoceptive threat memory can disrupt reconsolidation of naturalistic aversive memories in humans. More specifically, naturalistic interoceptive aversive memories, a form of transdiagnostic fear memory that contributes to the pathogenesis of fear-related disorders such as panic disorder, posttraumatic stress disorder (PTSD), and illness anxiety disorder.

METHODS

For this proof-of-concept, placebo-controlled double-blind trial, volunteers (n = 99) reporting elevated fears of somatic sensations will be stratified on biological sex and randomized to one of three intervention arms: (a). CBD-rich oil administered within the reconsolidation window, (b) Placebo oil administered within the reconsolidation window; or (c) CBD-rich oil administered outside of the reconsolidation window. Change in emotional reactivity to a 35% CO₂ challenge from baseline to two-week follow-up will serve as our primary outcome.

CONCLUSION

Study findings may contribute towards the development of a novel brief transdiagnostic intervention guided by reconsolidation theory for individuals prone to fear-related psychiatric disorders.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04726475.

An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial

BACKGROUND

Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation.

OBJECTIVE

This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation.

METHODS

In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones.

RESULTS

This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022.

CONCLUSIONS

If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/38905.

State and Trait Risk and Resilience Factors Associated with COVID-19 Impact and Obsessive-Compulsive Symptom Trajectories

The COVID-19 pandemic may exacerbate common symptoms of obsessive-compulsive disorder, such as fears of contamination or causing harm to others. To investigate the potential impact of COVID-19 on obsessive-compulsive (OC) symptoms, we utilized a frequent sampling prospective design to assess changes in OC symptoms between April 2020 and January 2021. We examined in a broad clinical and non-clinical sample whether baseline risk (e.g., emotion dysregulation, anxiety sensitivity, intolerance of uncertainty) and protective (e.g., resilience) factors would predict OC symptom changes, and whether coping strategies would mediate week-to-week changes in COVID-19 impact and OC symptoms. Emotion dysregulation was associated with greater likelihood of OC symptom worsening, whereas resilience was associated with lower likelihood. Longitudinal mediation analyses revealed that coping strategies were not significant mediators; however, changes in adaptive coping were associated with subsequent-week OC symptom reductions. Regardless of perceived COVID-19 impact, implementing adaptive coping strategies may prospectively reduce OC symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41811-021-00128-4.

Anxiety Sensitivity and Fatigue Severity Among Adults with Chronic Low Back Pain

BACKGROUND

The combined impact of chronic low back pain (CLBP) and fatigue severity is associated with increased burden and worsened symptoms. Understanding factors that may contribute to and maintain fatigue severity among individuals with CLBP is needed to isolate intervention modalities.

METHODS

The current study sought to investigate the role of anxiety sensitivity (AS) in terms of fatigue severity among 1,663 adults (70.0% female, M _age = 44.5 years, SD = 11.87) with current mild to severe CLBP as well as a subset of the sample with clinically significant fatigue (n = 778).

RESULTS

Results indicated AS was a positively and statistically significant predictor of fatigue severity among the entire sample and the subset of the sample with clinically significant fatigue.

CONCLUSIONS

These cross-sectional data highlight the potential promise of AS as an underrecognized cognitive vulnerability for greater fatigue severity among those with CLBP.

Anxiety sensitivity mediates relations between anxiety (but not depression) and problematic smartphone use severity, adjusting for age and sex, in Chinese adolescents early in the COVID-19 pandemic

Risk factors for problematic smartphone use (PSU) have rapidly become an important area of research due to the prevalence of smartphones and functional impairment associated with PSU. Our aim was to examine relations between established predictors of PSU (depression and anxiety) and a potential mediator of PSU (anxiety sensitivity; AS). Participants (N = 4752) from junior and senior high schools in Tianjin, China completed a web‐based survey with measures of depression, anxiety, AS, and PSU. Descriptive and inferential analyses revealed significant differences between males and females on depression severity, and between junior and senior high school students on AS and PSU severity. Results of structural equation modeling indicated that anxiety was positively associated with AS when adjusting for depression; and AS was significantly associated with greater PSU severity, adjusting for age and sex. Additionally, AS mediated relations between anxiety and PSU severity. Current findings on AS are consistent with theoretical models of problematic internet use (Interaction of Person‐Affect‐Cognition‐Execution) and previous research linking AS to other kinds of behavioral addictions (e.g., smoking, alcohol use).

Psychological Distress and Physical Health Symptoms in the Latinx Population During the COVID-19 Pandemic: Exploring the Role of Anxiety Sensitivity

Objective

The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial physical and mental health consequences. Rates of mortality and hospitalization are highest among those of racial and ethnic minority persons, including Latinx persons. Further, Latinx persons have been experiencing elevated mental health problems in response to the pandemic compared to non-Latinx Whites. The current study examined whether individual differences in anxiety sensitivity (AS) related to more severe emotional distress associated with social distancing, financial strain, fear of COVID-19, and physical health symptoms stemming from the COVID-19 pandemic among Latinx adults.

Methods

Participants included 188 Latinx persons (31.4% female, M_age = 34.1 years, SD = 8.16) recruited via an online survey panel program.

Results

Results indicated that AS significantly contributed to increased severity of the emotional stress response associated with social distancing (ΔR² = 0.15, p < 0.001), financial strain (ΔR² = 0.15, p < 0.001), physical health symptoms (ΔR² = 0.03, p = 0.006), and fear of COVID-19 (ΔR² = 0.15, p < 0.001). These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and work and home life COVID-19-related stress.

Conclusions

These cross-sectional findings suggest AS may be an important individual difference factor for better understanding mental health among Latinx persons in the context of the COVID-19 pandemic.

Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial

BACKGROUND

Interventions that target anxiety/depressive symptoms in the context of smoking treatment have shown promise irrespective of psychiatric diagnosis. Yet, these tailored treatments are largely absent for persons who smoke and are living with HIV (SLWH).

OBJECTIVE

To evaluate a novel, smoking cessation intervention that addresses anxiety/depression and HIV-related health (QUIT) against a time-matched control (TMC) and a standard of care (SOC) condition.

METHODS

SLWH (N = 180) will be recruited and enrolled from 3 medical clinics in Boston, MA, and Houston, TX. The trial will consist of a baseline assessment, a 10-week intervention/assessment period, and follow-up assessments, accounting for a total study duration of approximately 8 months. All participants will complete a baseline visit and a pre-randomization standardized psychoeducation visit, and will then be randomized to one of three conditions: QUIT, TMC, or SOC. QUIT and TMC will consist of nine 60-min, cognitive behavioral therapy-based, individual weekly counseling sessions using standard smoking cessation counseling; additionally, QUIT will target anxiety and depressive symptoms by addressing underlying mechanisms related to mood and quit difficulty. SOC participants will complete weekly self-report surveys for nine weeks. All participants will be encouraged to quit at Session 7 and will be offered nicotine replacement therapy to help.

CONCLUSIONS

QUIT is designed to improve smoking cessation in SLWH by addressing anxiety and depression and HIV-related health issues. If successful, the QUIT intervention would be ready for implementation and dissemination into "real-world" behavioral health and social service settings consistent with the four objectives outlined in NIDA's Strategic Plan.

Evaluating the psychometric properties of the e-cigarette barriers to cessation scale

Evidence suggests that electronic cigarette (e-cigarette) users have difficulty quitting e-cigarettes. The Electronic Cigarette Barriers to Cessation Scale (E-BCS) was developed to assess barriers to cessation among e-cigarette users. Yet, no work has evaluated the psychometric properties of the E-BCS. The current study utilized data from two independent samples of adult e-cigarette users to evaluate the psychometric properties and structure of the E-BCS. In Study 1, competing models of the E-BCS were evaluated, and initial construct validity and reliability were explored using data from 599 adult e-cigarettes users (52.3% female, M_age = 35.16 years, SD = 10.30). Results supported a unidimensional structure for the E-BCS comprised of 18 items. In Study 2, the unidimensional structure of the 18-item E-BCS and construct validity were evaluated among a sample of 516 current e-cigarette using adults (52.3% female; M_age = 34.74, SD = 11.37). Results confirmed the unidimensional structure, measurement invariance across sex, and construct validity across related e-cigarette behavior constructs and psychopathology for the E-BCS. These findings suggest that the E-BCS is a potentially useful clinical instrument for measuring barriers that may interfere with e-cigarette cessation.

Anxiety Sensitivity and Emotion Dysregulation in Dual and Exclusive E-Cigarette Users

Background: E-cigarette use has increased exponentially over the past decade, particularly among current combustible cigarette users. Preliminary evidence has demonstrated differences across exclusive and dual e-cigarette/combustible cigarette users, such that dual users represent a more clinically severe group. Yet, the extent to which these groups differ on critical transdiagnostic risk factors that may promote and maintain nicotine dependence, such as anxiety sensitivity and emotional dysregulation has yet to be systematically studied. The purpose of the current study was to examine differences between exclusive e-cigarette users and dual e-cigarette and combustible cigarette users in anxiety sensitivity and both global emotion regulation difficulties as well as within specific emotion regulation difficulty domains. Methods: Participants were 192 exclusive e-cigarette users and 315 dual e-cigarette and combustible cigarette users (52.1% female, Mage = 34.8 years, SD = 11.42). Results: Compared to exclusive e-cigarette users, dual users reported higher anxiety sensitivity, overall emotion regulation difficulties, and specific emotion regulation difficulties related to impulse control and lack of access to effective emotion regulation strategies. There were no group differences in emotion regulation difficulties related to emotional clarity, ability to engage in goal-directed behavior when upset, and emotional non-acceptance. Conclusion: The current data suggest that dual users are an at-risk group in terms of emotional processes. Dual users would likely benefit from targeted intervention efforts focused on reducing anxiety sensitivity and improving emotion regulation in order to reduce nicotine consumption and/or promote cessation.

Exploring transdiagnostic processes for chronic pain and opioid misuse among two studies of adults with chronic pain

Chronic pain is a significant public health problem associated with functional impairment, increased medical expenditures, and opioid misuse. Recent work has suggested that certain transdiagnostic psychosocial factors may be more important than pain intensity to better understand pain and opioid outcomes. Specifically, pain-related anxiety, anxiety sensitivity, emotion dysregulation, and distress tolerance have all been uniquely associated with both pain and opioid outcomes across a range of samples. Yet, no work has examined how these transdiagnostic constructs relate to pain and opioid misuse when accounting for the other constructs. Therefore, the current study employed two independent sample of adults with chronic pain to examine (1) the construct independence of each of these factors using exploratory structural equation modelling (ESEM) and (2) how each of these constructs relates to pain and opioid outcomes in latent structural models. Results from Study 1 provided empirical support for construct independence of the transdiagnostic constructs. Findings from Study 2 indicated that pain-related anxiety was most strongly related to pain intensity, interference, and pain-related negative affect, anxiety sensitivity with opioid misuse, and emotion dysregulation with all studied criterion variables. The current results highlight the importance of assessing and targeting transdiagnostic constructs among adults with pain.

The Role of Anxiety Sensitivity in terms of Weight-related Impairment and Fatigue Severity among Adults with Obesity and Chronic Low Back Pain

BACKGROUND

Obesity and chronic low back pain often co-occur and are associated with psychosocial and physical impairments such as weight-related impairment and fatigue. Yet, there is little understanding of psychological factors that may be associated with weight-related impairment and fatigue (a psychosocial factor) among this vulnerable population.

METHODS

Thus, the current study examined the role of anxiety sensitivity as it relates to self-reported weight-related impairment and fatigue severity among persons with obesity and chronic low back pain. Participants included a nationally representative sample of adults (N = 616) with co-occurring obesity and chronic low back pain (77.3% female, M age = 45.9 years, SD = 11.53).

RESULTS

Results revealed that anxiety sensitivity was associated with greater levels of weight-related impairment and fatigue severity after controlling for age, sex, body mass index (BMI), pain interference, and perceived general health.

CONCLUSIONS

The findings suggest that anxiety sensitivity may be a mechanistic target for better understanding and addressing weight-related impairment and fatigue severity among individuals with obesity and chronic low back pain.