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Fergerson AK, Cordova EA, Dawson D, Hunter LR, Raines AM. Differences in Anxiety Sensitivity Among Black and White Veterans. J Racial Ethn Health Disparities 2024; 11:1301-1307. [PMID: 37129783 DOI: 10.1007/s40615-023-01609-2] [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: 01/24/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
Black Americans are at greater risk for more severe and enduring consequences of anxiety disorders than White Americans, highlighting the need to identify malleable risk and maintenance factors. The current study aimed to examine racial differences in anxiety sensitivity and anxiety sensitivity facets between Black and White veterans (N = 285; 58% Black, 77% Male; Mage = 43.51, SD = 11.87) presenting to a PTSD specialty clinic at a Veterans Affairs (VA) hospital. In addition to a diagnostic interview, veterans were asked to complete a brief battery of self-report questionnaires to assist with diagnostic clarification and treatment planning. Results revealed a significant difference in anxiety sensitivity total scores between Black (M = 44.5, SD = 17.2) and White veterans (M = 36.1, SD = 17.7), such that Black veterans evinced higher levels. When examining anxiety sensitivity subfacets, Black veterans also evinced elevated levels of physical (M = 14.4, SD = 6.6) and cognitive concerns (M = 15.2, SD = 6.5) compared to White veterans (M = 9.8, SD = 6.2; M = 11.7, SD = 6.6, respectively). Results indicate that anxiety sensitivity is a relevant risk factor among Black veterans. Future studies should examine the extent to which anxiety sensitivity is modifiable in such populations.
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Affiliation(s)
- Ava K Fergerson
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA, USA
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Emily A Cordova
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Darius Dawson
- Michael E. DeBakey VA Medical Center, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center, Virtual Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA, USA.
- South Central Mental Illness Research, Education and Clinical Center, Virtual Center, Houston, TX, USA.
- School of Medicine, Louisiana State University, New Orleans, LA, USA.
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2
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Flynt S, Koscinski B, Accorso C, Knapp A, Gorka S, Suhr J, Austin M, Allan NP. A One-Arm Pilot Trial of a Telehealth CBT-Based Group Intervention Targeting Transdiagnostic Risk for Emotional Distress. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.23.24306218. [PMID: 38712129 PMCID: PMC11071586 DOI: 10.1101/2024.04.23.24306218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The COVID-19 pandemic had a significant impact on mental health, straining an already overburdened healthcare system. A modular, transdiagnostic approach to treating psychopathology may be ideal to target common transdiagnostic risk factors for emotional distress and related disorders likely to be impacted by circumstances related to this once-in-a-lifetime environmental stressor. Anxiety sensitivity (AS), or fear of anxious arousal, intolerance of uncertainty (IU), or distress when confronted with uncertainty, and loneliness are three transdiagnostic risk factors impacted by the pandemic and robust predictors of emotional distress beyond that. We completed a pilot feasibility, acceptability, and utility trial of Coping Crew, our group, telehealth-delivered transdiagnostic treatment protocol in 17 participants who completed the intervention (M age = 22.00, SD = 4.46; 71% female). The intervention and study protocol were feasible to deliver and were rated as acceptable and useful to address intervention targets. Evidence was mixed regarding feasibility, acceptability, and usefulness of the mobile app component. Sixteen of 17 participants (94%) completed at least one survey a day on 80% of the days but only 6 participants (35%) completed at least 80% of the mobile app surveys delivered over the course of the intervention. Most participants rated use of the app as acceptable and relevant to psychological improvements made due to the intervention. Sizeable effect size reductions in transdiagnostic risk factors were found at post-intervention and maintained at 1- and 3-month follow-up, supporting next steps in the development of this modular transdiagnostic treatment.
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Affiliation(s)
- Sierra Flynt
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | | | - Ashley Knapp
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | | | | | - Nicholas P. Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States
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3
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Jemcov A, Olthuis JV, Watt MC, Stewart SH. Do anxiety sensitivity cognitive concerns and/or depression symptoms independently explain sleep disturbances in a high anxiety sensitive treatment-seeking sample? J Anxiety Disord 2023; 97:102731. [PMID: 37236069 DOI: 10.1016/j.janxdis.2023.102731] [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: 07/13/2022] [Revised: 05/08/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
Cognitive models of insomnia posit a role for anxiety sensitivity (AS) in sleep difficulties. While sleep disturbances have been linked to AS, particularly AS cognitive concerns, prior studies have rarely accounted for the correlated construct of depression. We used pre-treatment intervention trial data from 128 high AS, treatment-seeking adults with a DSM-5 diagnosis of an anxiety, depressive, or posttraumatic stress disorder to determine whether AS cognitive concerns and/or depression are independently associated with sleep impairment domains (e.g., sleep quality, latency, daytime dysfunction). Participants provided data on AS, depressive symptoms, and sleep impairments. AS cognitive concerns (but not other AS dimensions) were correlated with four of five sleep impairment domains; depression was correlated with all five. Multiple regressions revealed four of five sleep impairment domains were predicted by depression with no independent contribution of AS cognitive concerns. In contrast, AS cognitive concerns and depression were independently associated with daytime dysfunction. Results suggest previous findings linking AS cognitive concerns to sleep impairments may have been largely secondary to the overlap of cognitive concerns with depression. Findings demonstrate the importance of incorporating depression into the cognitive model of insomnia. Both AS cognitive concerns and depression may be useful targets for reducing daytime dysfunction.
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Affiliation(s)
- Anastasija Jemcov
- Department of Psychology and Neuroscience, Faculty of Science, Dalhousie University, 1355 Oxford St., Halifax, Nova Scotia B3H 4R2, Canada
| | - Janine V Olthuis
- Department of Psychology, Faculty of Arts, University of New Brunswick, 38 Dineen Drive, Fredericton, New Brunswick E3B 5A3, Canada
| | - Margo C Watt
- Department of Psychology, Faculty of Science, St. Francis Xavier University, 2323 Notre Dame Ave., Antigonish, Nova Scotia B2G 2W5, Canada
| | - Sherry H Stewart
- Department of Psychology and Neuroscience, Faculty of Science, Dalhousie University, 1355 Oxford St., Halifax, Nova Scotia B3H 4R2, Canada; Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veteran's Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada.
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4
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Allan NP, Gorka SM, Saulnier KG, Bryan CJ. Anxiety Sensitivity and Intolerance of Uncertainty: Transdiagnostic Risk Factors for Anxiety as Targets to Reduce Risk of Suicide. Curr Psychiatry Rep 2023; 25:139-147. [PMID: 37000403 PMCID: PMC10064604 DOI: 10.1007/s11920-023-01413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE OF REVIEW Suicide has a profound impact on individuals, families, and society. One prominent, if understudied, risk factor for suicide is anxiety. More than 70% of people with at least one suicide attempt meet diagnostic criteria for an anxiety disorder. There are several limitations to exploring the associations between anxiety and suicide using diagnosis-based classification systems. A better approach would be to consider transdiagnostic risk factors for anxiety. RECENT FINDINGS Through a negative reinforcement model of suicide, anxiety sensitivity (AS) and intolerance of uncertainty (IU) appear to exacerbate the experience of unpleasant anxiety sensations and likely contribute to chronic suicide risk as well as acute suicidal acts. Although more research is needed to clarify the mechanisms through which AS and IU confer risk, brief interventions may offer an ideal suicide prevention strategy for anxious people.
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Affiliation(s)
- Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA.
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, USA.
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | - Kevin G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, USA
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Okajima I, Kadotani H. Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety among City Government Employees in Japan. Clocks Sleep 2023; 5:167-176. [PMID: 37092427 PMCID: PMC10123658 DOI: 10.3390/clockssleep5020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
It has recently been noted that a reduction in sleep reactivity, characterized as the trait-like degree to which exposure to stress interferes with sleep, and anxiety sensitivity are associated with reduced insomnia severity. This study aimed to examine whether sleep reactivity and anxiety sensitivity are associated with insomnia-related depression and anxiety among city government employees in Japan. This cross-sectional study included 1810 city government employees of Koka City, Japan (mean age (standard deviation): 45.33 (12.20) years) who completely answered the scales for sleep reactivity, anxiety sensitivity, anxiety, and depression. Stepwise multiple regression analysis adjusted for demographic data showed that anxiety sensitivity (β = 0.39) was significantly linked to anxiety, and sleep reactivity (β = 0.36) was significantly linked to depression in individuals with insomnia. Additionally, the results of a logistic regression analysis adjusted for demographic data showed that anxiety sensitivity and sleep reactivity were relevant factors for anxious insomnia (OR = 12.69) and depressive insomnia (OR = 8.73), respectively. Whereas both sleep reactivity (OR = 14.67) and anxiety sensitivity (OR = 6.14) were associated with combined insomnia. These findings indicate that sleep reactivity is strongly associated with depressive symptoms, and anxiety sensitivity is strongly associated with anxiety symptoms in individuals with insomnia.
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The Role of Anxiety Sensitivity in the Association Between Childhood Maltreatment and Sleep Disturbance Among Adults in Psychiatric Inpatient Treatment. J Nerv Ment Dis 2023; 211:306-313. [PMID: 36801864 DOI: 10.1097/nmd.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The present investigation examined associations of childhood maltreatment, anxiety sensitivity (AS), and sleep disturbance among a diverse sample of adults in psychiatric inpatient treatment. We hypothesized that childhood maltreatment would be indirectly associated with greater sleep disturbance through elevated AS. Exploratory analyses examined the indirect effect models with three AS subscales (i.e., physical, cognitive, and social concerns) as parallel mediators. A sample of adults in acute-care psychiatric inpatient treatment (N = 88; 62.5% male; Mage = 33.32 years, SD = 11.07; 45.5% White) completed a series of self-report measures. After accounting for theoretically relevant covariates, childhood maltreatment was indirectly associated with sleep disturbance through AS. Parallel mediation analyses revealed that no individual subscale of AS significantly accounted for this association. These findings suggest that heightened levels of AS may explain the association between childhood maltreatment and sleep disturbance among adults in psychiatric inpatient treatment. Interventions targeting AS can be brief and efficacious and have the potential to improve clinical outcomes among psychiatric populations.
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7
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Short NA, van Rooij SJH, Murty VP, Stevens JS, An X, Ji Y, McLean SA, House SL, Beaudoin FL, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, Jovanovic T. Anxiety sensitivity as a transdiagnostic risk factor for trajectories of adverse posttraumatic neuropsychiatric sequelae in the AURORA study. J Psychiatr Res 2022; 156:45-54. [PMID: 36242943 PMCID: PMC10960961 DOI: 10.1016/j.jpsychires.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
Anxiety sensitivity, or fear of anxious arousal, is cross-sectionally associated with a wide array of adverse posttraumatic neuropsychiatric sequelae, including symptoms of posttraumatic stress disorder, depression, anxiety, sleep disturbance, pain, and somatization. The current study utilizes a large-scale, multi-site, prospective study of trauma survivors presenting to emergency departments. Hypotheses tested whether elevated anxiety sensitivity in the immediate posttrauma period is associated with more severe and persistent trajectories of common adverse posttraumatic neuropsychiatric sequelae in the eight weeks posttrauma. Participants from the AURORA study (n = 2,269 recruited from 23 emergency departments) completed self-report assessments over eight weeks posttrauma. Associations between heightened anxiety sensitivity and more severe and/or persistent trajectories of trauma-related symptoms identified by growth mixture modeling were analyzed. Anxiety sensitivity assessed two weeks posttrauma was associated with severe and/or persistent posttraumatic stress, depression, anxiety, sleep disturbance, pain, and somatic symptoms in the eight weeks posttrauma. Effect sizes were in the small to medium range in multivariate models accounting for various demographic, trauma-related, pre-trauma mental health-related, and personality-related factors. Anxiety sensitivity may be a useful transdiagnostic risk factor in the immediate posttraumatic period identifying individuals at risk for the development of adverse posttraumatic neuropsychiatric sequelae. Further, considering anxiety sensitivity is malleable via brief intervention, it could be a useful secondary prevention target. Future research should continue to evaluate associations between anxiety sensitivity and trauma-related pathology.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Psychology, University of Nevada, Las Vegas, NV, 89154, USA.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, 19121, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, The Brown University School of Public Health, Providence, RI, 02930, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; The Many Brains Project, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, 43210, USA; Ohio State University College of Nursing, Columbus, OH, 43210, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, 19141, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, 48202, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, 06510, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA; Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, 2065, Australia; Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, 48202, USA
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Otto MW, Lubin RE, Rosenfield D, Taylor DJ, Birk JL, Espie CA, Shechter A, Edmondson D, Shepherd JM, Zvolensky MJ. The association between race- and ethnicity-related stressors and sleep: the role of rumination and anxiety sensitivity. Sleep 2022; 45:zsac117. [PMID: 35639820 PMCID: PMC9548665 DOI: 10.1093/sleep/zsac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/30/2022] [Indexed: 07/29/2023] Open
Abstract
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.
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Affiliation(s)
- Michael W Otto
- Corresponding author. Michael W. Otto, Department of Psychological and Brain Sciences, Boston University, 900E Commonwealth Ave., Boston, MA, 02215. E-mail:
| | - Rebecca E Lubin
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX,USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,USA
- HEALTH Institute, University of Houston, Houston, TX,USA
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9
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Short NA, Evans MK, Raudales AM, Shapiro M, Weiss NH, Schmidt NB. Anxiety sensitivity and cannabis use motives among trauma-exposed young adult cannabis users. Am J Addict 2022; 31:242-250. [PMID: 35365953 PMCID: PMC9117414 DOI: 10.1111/ajad.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 01/18/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Anxiety sensitivity, or fear of anxious arousal, may be an important risk factor for problematic cannabis use. Specifically, anxiety sensitivity may motivate cannabis use to cope with distress, particularly among trauma-exposed individuals. The current study tested associations among anxiety sensitivity, its subdomains, and cannabis use motives in a sample of trauma-exposed cannabis users. We hypothesized elevated anxiety sensitivity, particularly cognitive concerns, would be associated with increased maladaptive coping use motives, after covarying for the number of traumas and cannabis use quantity. METHOD Hypotheses were tested in a cross-sectional study of trauma-exposed young adult cannabis users (N = 56) (Mage = 20.7 years, 59% women, 73% white). Participants completed self-report measures, and a clinical interview assessing cannabis use quantity. RESULTS Multiple regression analyses indicated that elevated anxiety sensitivity was associated with increased cannabis use coping motives, after covarying for the number of traumas experienced and cannabis use quantity. Specifically, higher levels of anxiety sensitivity cognitive and social concerns were associated with coping motives for cannabis use. DISCUSSION AND CONCLUSIONS Anxiety sensitivity, particularly concerns about cognitive dyscontrol and negative social evaluations of anxious arousal, may motivate cannabis use to cope with stress among trauma-exposed cannabis users. Future research should include prospective studies with diverse samples to replicate results and determine whether intervening on anxiety sensitivity could reduce maladaptive coping motives for cannabis use. SCIENTIFIC SIGNIFICANCE The current study replicates prior research indicating anxiety sensitivity, particularly cognitive concerns, is associated with maladaptive cannabis use. Expanding on prior research, findings indicated anxiety sensitivity is associated with coping motives for cannabis use among trauma-exposed cannabis users.
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Affiliation(s)
- Nicole A. Short
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mariah K. Evans
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Alexa M. Raudales
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Mary Shapiro
- Southeastern Louisiana VA Health Care System, New Orleans, LA
| | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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10
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Ubara A, Tanizawa N, Harata M, Suh S, Yang CM, Li X, Okajima I. How Does E-mail-Delivered Cognitive Behavioral Therapy Work for Young Adults (18-28 Years) with Insomnia? Mediators of Changes in Insomnia, Depression, Anxiety, and Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084423. [PMID: 35457291 PMCID: PMC9029643 DOI: 10.3390/ijerph19084423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022]
Abstract
This study examined whether cognitive behavioral therapy (CBT) for insomnia (CBT-I) improved insomnia severity, by changing sleep-related mediating factors. It also examined whether an improvement in insomnia led to enhanced mental health. This study was a secondary analysis of a randomized controlled trial of e-mail-delivered CBT-I for young adults with insomnia. The participants were randomized to either CBT-I or self-monitoring. The mental health-related measures were depression, anxiety, and stress. The sleep-related mediating factors were sleep hygiene practices, dysfunctional beliefs, sleep reactivity, and pre-sleep arousal. A total of 41 participants, who completed all the sessions (71% females; mean age 19.71 ± 1.98 years), were included in the analysis. The hierarchical multiple regression analysis showed that 53% of the variance in the improvements in insomnia severity was explained by the treatment group (β = −0.53; ΔR2 = 0.25; p < 0.01) and the changes in sleep reactivity (β = 0.39; ΔR2 = 0.28; p < 0.05). Moreover, the mediation analysis showed that the reductions in depression and stress were explained by the changes in insomnia severity; however, anxiety symptoms were not reduced. CBT-I for young adults suggested that sleep reactivity is a significant mediator that reduces insomnia severity, and that the alleviation and prevention of depression and stress would occur with the improvement in insomnia.
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Affiliation(s)
- Ayaka Ubara
- Graduate School of Psychology, Doshisha University, Kyoto 610-0321, Japan;
- JSPS Research Fellowship, Chiyoda-ku, Tokyo 102-0083, Japan
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Noriko Tanizawa
- Department of Innovation Laboratories, NEC Solution Innovators, Ltd., Tokyo 136-8627, Japan;
| | - Megumi Harata
- Public Children Support Center, Adachi-ku, Tokyo 121-0816, Japan;
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women’s University, Seoul 02844, Korea;
| | - Chien-Ming Yang
- Department of Psychology, National Chengchi University, Taipei 11605, Taiwan;
- The Research Center for Mind, Brain & Learning, National Chengchi University, Taipei 11605, Taiwan
| | - Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong, China;
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Isa Okajima
- Department of Psychological Counseling, Tokyo Kasei University, Tokyo 173-8602, Japan
- Faculty of Human Sciences, Waseda University, Saitama 359-1192, Japan
- Correspondence: ; Tel.: +81-3-3961-5276
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11
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Garey L, Hébert ET, Mayorga NA, Chavez JF, Shepherd JM, Businelle MS, Zvolensky MJ. Evaluating the feasibility and acceptability of a mobile-based health technology for smoking cessation: Mobile Anxiety Sensitivity Program. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61 Suppl 1:111-129. [PMID: 33939190 PMCID: PMC8563508 DOI: 10.1111/bjc.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/21/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Cigarette smoking is the leading preventable cause of death and disability. Although most US smokers want to quit, more than 95% of cessation attempts end in relapse within 6 months. To improve cessation outcomes, research has turned to targetable mechanisms, such as anxiety sensitivity (AS), which maintain smoking behaviour, impede cessation success, and can be effectively targeted in the context of psychosocial interventions. Although integrated treatment programmes that address AS reduction in the context of smoking cessation have demonstrated promising results, presently, no mobile, technology-based integrated treatment exists to expressly address smoking and AS. The current study evaluated the initial feasibility and acceptability of a mobile smoking cessation intervention, Mobile Anxiety Sensitivity Program for smoking (MASP). METHODS Participants were 15 daily adult combustible cigarette smokers (females n = 6, Mage = 46.5 years, SD = 13.3) who completed a 6-week total intervention period (baseline visit, 2 weeks pre-quit, 4 weeks post-quit, follow-up visit). RESULTS Most participants (N = 12) completed the full 6-week intervention, and participant engagement with MASP was high. Participants reported that MASP was acceptable. Biochemical verification of smoking abstinence indicated 25% of smokers were abstinent for at least 24 hr prior to the in-person 4 weeks post-quit follow-up visit. CONCLUSIONS Findings indicated that MASP has the potential to provide effective assistance to those wanting to quit cigarettes. PRACTITIONER POINTS Mobile-based smoking cessation interventions may be a promising treatment option, particularly for those of lower socio-economic status. Targeting AS in the context of a mobile-based smoking cessation app may be a viable way to improve smoking cessation success and treatment outcome. Due to the pilot nature of this study, there was no control group. Thus, comparative conclusions and generalizability based on the current study must be made with caution.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Texas, USA
| | - Emily T. Hébert
- University of Texas Health Science Center (UTHealth) School of Public Health,Austin, Texas, USA
| | | | | | | | - Michael S. Businelle
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Texas, USA,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,HEALTH Institute, University of Houston, Texas, USA,Corresponding author: Michael J. Zvolensky, Ph.D., Dept of Psychology, 3695 Cullen Blvd., Room 126. University of Houston, Houston, TX, 77204. (713) 743-8056,
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12
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Fitzgerald HE, Hoyt DL, Kredlow MA, Smits JAJ, Schmidt NB, Edmondson D, Otto MW. Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2021; 28:323-337. [PMID: 35300171 PMCID: PMC8923531 DOI: 10.1037/cps0000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.
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Affiliation(s)
- Hayley E Fitzgerald
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - Danielle L Hoyt
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - M Alexandra Kredlow
- Department of Psychology, Harvard University, 52 Oxford Street, Cambridge, MA 02140
| | - Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23 St., Austin, TX 78712
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | | | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
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13
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Nitturi V, Chen TA, Zvolensky MJ, McNeill LH, Obasi EM, Reitzel LR. Anxiety Sensitivity and Fast-Food Ordering Habits Among Black Adults. HEALTH BEHAVIOR RESEARCH 2021; 4. [PMID: 34541461 DOI: 10.4148/2572-1836.1086] [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: 11/04/2022] Open
Abstract
Background Black adults experience high rates of overweight/obesity, which is linked to chronic diseases and is exacerbated by fast-food consumption. Anxiety sensitivity, a relative stable fear of anxiety-related sensations, has been linked to high caloric intake. Here, we examine whether anxiety sensitivity is associated with fast-food ordering habits within a convenience sample of Black adults. Methods Of 124 adults (79.4% women; Mage=49.3±11.6; 84.8% overweight/obese), 107 (86.3%) reported eating from a fast-food restaurant in the last month. Participants completed the Anxiety Sensitivity-Index 3, which has a total score and physical, cognitive, and social concerns subscales. Investigator-generated items queried frequency of ordering "supersized" quantities of fast-food (e.g., cheeseburgers, fries), and healthy items (e.g., salads, oatmeal, yogurt), respectively, from "never" to "always." Covariate-adjusted ordinal logistic regression models were used to assess relations between measures of interest. Results Anxiety sensitivity (total and physical concerns) was associated with greater odds of more frequently ordering supersized unhealthy fast-food; and anxiety sensitivity (total and cognitive concerns) was associated with lower odds of more frequently ordering healthy items from fast-food restaurants. Conclusions Results suggest that adults with greater anxiety sensitivity may engage in fast-food ordering habits that can contribute to the overweight/obesity epidemic. Future studies should replicate results and determine the potential for anxiety sensitivity-reduction interventions to affect dietary choices that contribute to overweight/obesity.
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Affiliation(s)
- Vijay Nitturi
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
| | - Tzu-An Chen
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
| | - Michael J Zvolensky
- The University of Houston, HEALTH Research Institute, The University of Houston, College of Liberal Arts and Social Sciences, Department of Psychology, and The University of Texas MD Anderson Cancer Center, Department of Behavioral Sciences, Houston, Texas
| | - Lorna H McNeill
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX
| | - Ezemenari M Obasi
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
| | - Lorraine R Reitzel
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
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14
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O'Bryan EM, McLeish AC, Norr AM, Ely S, Bass Z, Davies CD, Capron DW, Schmidt NB, Mano KEJ. A randomized controlled trial evaluating the efficacy of a brief computerized anxiety sensitivity reduction intervention for health anxiety. J Anxiety Disord 2021; 82:102425. [PMID: 34082279 DOI: 10.1016/j.janxdis.2021.102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/20/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
It is estimated that individuals with severe health anxiety (HA) utilize 41 %-78 % more healthcare resources than individuals with identified medical diagnoses. Thus, identifying targets for intervention and prevention efforts for HA that are appropriate for primary care or specialty clinic settings is imperative. The aim of the present investigation was to evaluate the effect of a single-session, computerized anxiety sensitivity (AS) intervention on AS and HA. Participants were 68 university students (79.4 % female; Mage = 19.68) with elevated levels of AS and HA. Participants were randomized to either the AS intervention condition or an active control condition and completed self-report and behavioral follow-up assessments at post-intervention, 1-week follow-up, and 1-month follow-up. Results indicated a significant Time x Condition interaction for ASI-3 at each follow-up assessment (all ps < .001), such that individuals in the active condition exhibited greater reductions in AS compared to the control condition. There was no significant Time x Condition interaction for HA at any follow-up. Mediation analyses revealed a significant indirect effect of Condition on changes in HA through changes in AS. No significant effects were observed for behavioral outcomes. Findings suggest that this intervention successfully reduces AS among those who are high in HA and AS and may indirectly contribute to reductions in HA over time through reductions in AS.
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Affiliation(s)
- Emily M O'Bryan
- Department of Psychology, University of Cincinnati, USA; Anxiety Disorders Center, Hartford Hospital/Institute of Living, USA. Emily.O'
| | | | - Aaron M Norr
- VA VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, USA
| | - Sarah Ely
- Department of Psychology, University of Cincinnati, USA
| | - Zoey Bass
- Department of Psychology, University of Cincinnati, USA
| | - Carolyn D Davies
- Anxiety Disorders Center, Hartford Hospital/Institute of Living, USA; Department of Psychological and Brain Sciences, University of Massachusetts Amherst, USA
| | - Daniel W Capron
- School of Psychology, University of Southern Mississippi, USA
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15
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McNett S, Lind MJ, Brown RC, Hawn S, Berenz EC, Brown E, McDonald SD, Pickett T, Danielson CK, Thomas S, Amstadter AB. Sleep Quality Moderates the Relationship between Anxiety Sensitivity and PTSD Symptoms in Combat-exposed Veterans. Behav Sleep Med 2021; 19:208-220. [PMID: 32063030 DOI: 10.1080/15402002.2020.1726749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective/Background: Posttraumatic stress disorder (PTSD) and related conditions (e.g., depression) are common in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. High anxiety sensitivity (AS), defined as fear of anxiety and anxiety-related consequences, is related to greater PTSD and depressive symptoms; however, few studies have identified possible modifiers of these associations. The current study examined the moderating role of sleep quality in the associations between AS and PTSD and depressive symptoms. Participants: Participants were 155 OEF/OIF/OND community veterans ages 21-40 (12.3% women). Methods: Participants completed a semi-structured clinical interview for DSM-IV PTSD symptoms (Clinician Administered PTSD Scale; CAPS) and self-report measures of anxiety sensitivity (Anxiety Sensitivity Index), sleep quality (Pittsburgh Sleep Quality Index global score; PSQI), and depressive symptoms (Beck Depression Inventory-II; BDI-II). Results: Results of hierarchical linear regression models indicated that the main effects of AS and global PSQI score were significantly associated with greater PTSD and depressive symptoms (both with sleep items removed), above and beyond the covariates of trauma load and military rank. Sleep quality moderated the relationship between AS and PTSD symptoms (but not depressive symptoms), such that greater AS was associated with greater PTSD symptoms for individuals with good sleep quality, but not poor sleep quality. Conclusions: Sleep quality and AS account for unique variance in PTSD and depressive symptoms in combat-exposed veterans. AS may be less relevant to understanding risk for PTSD among combat-exposed veterans experiencing poor sleep quality.
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Affiliation(s)
- Sage McNett
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Mackenzie J Lind
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Ruth C Brown
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia
| | - Sage Hawn
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| | - Erin C Berenz
- Department of Psychology, University of Illinois at Chicago , Illinois
| | - Emily Brown
- Dornsife School of Public Health, Drexel University , Philadelphia, Pennsylvania
| | - Scott D McDonald
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia.,Hunter Holmes McGuire VA Medical Center , Richmond, Virginia.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University , Richmond, Virginia
| | - Treven Pickett
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia.,Hunter Holmes McGuire VA Medical Center , Richmond, Virginia.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University , Richmond, Virginia
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Suzanne Thomas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Ananda B Amstadter
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond, Virginia.,Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
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16
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Garey L, Smit T, Neighbors C, Gallagher MW, Zvolensky MJ. Personalized Feedback for Smoking and Anxiety Sensitivity: A Randomized Controlled Trial. Subst Use Misuse 2021; 56:929-940. [PMID: 33761839 PMCID: PMC10032029 DOI: 10.1080/10826084.2021.1900255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cigarette smoking is the leading preventable cause of death and disability globally. Most smokers want to quit, and most make a serious quit attempt each year. Nevertheless, more than 95% of cessation attempters relapse within six months. Thus, alternative interventions are needed to combat this major public health concern. Objective: The current study was conducted to develop and test a smoking treatment among 95 (63.2% male; Mage = 46.20 years, SD = 10.90) adult daily cigarette smokers that targets a known risk factor for smoking maintenance and relapse: anxiety sensitivity (AS). Methods: The current study employed a randomized controlled trial design to test an integrated, brief, computer-delivered smoking and AS intervention among current, daily smokers. Participants completed four appointments: (a) phone-screener; (b) baseline (pre-intervention assessment, intervention [personalized feedback intervention (PFI) versus smoking information control], and post-intervention assessment); (c) 2-week follow-up; and (d) 4-week follow-up. Results: Participants indicated highly positive evaluations of both the PFI and control intervention. Between the baseline and 2-week follow-up, 44.2% [PFI: 46.9% (n = 23); control: 41.3% (n = 19)] of participants reported a quit attempt. At the 4-week follow-up, 49.5% [PFI: 57.1% (n = 28); control: 41.3% (n = 19)] of participants reported a quit attempt since their previous laboratory session. Conclusion: Within the context of an intervention development approach, the present investigation provides descriptive data on the feasibility, acceptability, and initial efficacy of a single-session, computer-delivered, AS/smoking PFI.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
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17
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Short NA, Boffa JW, Wissemann K, Schmidt NB. Insomnia symptoms predict the development of post-traumatic stress symptoms following an experimental trauma. J Sleep Res 2019; 29:e12909. [PMID: 31569285 DOI: 10.1111/jsr.12909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/18/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023]
Abstract
Insomnia symptoms prior to traumatic event exposure predict the development of post-traumatic stress symptoms. However, potential mechanisms underlying the association between insomnia and risk for post-traumatic stress disorder symptoms have not been prospectively tested. The current study used the trauma film paradigm to test whether insomnia symptoms prior to analogue trauma exposure predict subsequent analogue post-traumatic stress disorder symptoms, and potential mediators of this relationship, among an at-risk sample of 108 participants. Results indicated that, after covarying for negative affectivity, insomnia symptoms in the 2 weeks prior to analogue trauma exposure significantly predicted increased post-traumatic stress disorder symptoms 3 days and 1 week post-exposure. Moreover, distress immediately after exposure and post-traumatic avoidance mediated the association between insomnia symptoms and post-traumatic stress disorder symptoms 1 week after exposure. Effect sizes were small. The current study uses an analogue trauma and analogue post-traumatic stress disorder symptoms to model clinical symptoms, includes an additional intervention prior to analogue trauma, and lacks a control film. Findings suggest increased reactivity to trauma exposure and subsequent reminders, and attempts to suppress trauma memories may be mechanisms in the association between insomnia symptoms and risk for post-traumatic stress disorder symptoms.
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Affiliation(s)
- Nicole A Short
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Joseph W Boffa
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Karl Wissemann
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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18
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Horenstein A, Potter CM, Heimberg RG. How does anxiety sensitivity increase risk of chronic medical conditions? CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arielle Horenstein
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
| | - Carrie M. Potter
- Department of Psychiatry of Cambridge Health Alliance; Harvard Medical School; Boston Massachusetts
| | - Richard G. Heimberg
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
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19
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Dixon LJ, Lee AA, Gratz KL, Tull MT. Anxiety sensitivity and sleep disturbance: Investigating associations among patients with co-occurring anxiety and substance use disorders. J Anxiety Disord 2018; 53:9-15. [PMID: 29127882 DOI: 10.1016/j.janxdis.2017.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 01/04/2023]
Abstract
Sleep disturbance is a common problem among individuals with anxiety and substance use disorders (SUD). Anxiety sensitivity (AS) is elevated in patients with anxiety disorders and SUD and has been linked to sleep-related problems, including insomnia and somnolence (i.e., daytime sleepiness). We examined the unique roles of AS cognitive, physical, and social concerns in sleep disturbance among a sample of 99 residential SUD patients with anxiety disorders. Clinical levels of insomnia or somnolence were evidenced by 53.5% of the sample. Consistent with predictions, AS physical concerns was significantly associated with insomnia, and AS cognitive concerns was significantly related to insomnia and somnolence. Hierarchical linear regression models were conducted to test the association of AS cognitive and physical concerns with insomnia and somnolence symptoms while controlling for relevant factors. AS cognitive concerns accounted for unique variance, above and beyond withdrawal symptoms, anxiety, and depressive symptoms, in the model examining insomnia symptoms (B=0.30, SE=0.13, p=0.023). Results suggest that AS cognitive concerns may represent an important transdiagnostic mechanism underlying sleep disturbance among individuals with dual diagnosis.
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Affiliation(s)
- Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS 38677, United States.
| | - Aaron A Lee
- VA Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 W. Bancroft, Toledo, OH 43606, United States
| | - Matthew T Tull
- Department of Psychology, University of Toledo, 2801 W. Bancroft, Toledo, OH 43606, United States
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20
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Short NA, Boffa JW, King S, Albanese BJ, Allan NP, Schmidt NB. A randomized clinical trial examining the effects of an anxiety sensitivity intervention on insomnia symptoms: Replication and extension. Behav Res Ther 2017; 99:108-116. [PMID: 29035703 PMCID: PMC6397652 DOI: 10.1016/j.brat.2017.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022]
Abstract
Insomnia disorder is impairing and prevalent, particularly among individuals with comorbid anxiety disorders. Despite the availability of effective computerized treatments for insomnia, there are few that target both insomnia as well as co-occurring anxiety symptoms. The current study tests the efficacy of a computerized treatment for anxiety sensitivity cognitive concerns, a transdiagnostic risk factor for anxiety, mood, and insomnia symptoms, against a repeated contact control, on reducing insomnia symptoms. Hypotheses were tested in a mixed clinical sample of community individuals presenting for a treatment study (n = 151) who were followed up 1-, 3- and 6-months after treatment. Results indicated that the anxiety sensitivity intervention resulted in reductions in insomnia symptoms and clinically significant insomnia scores at 3- and 6-month follow-ups. These reductions remained significant when covarying for concurrent reductions in depression and anxiety. Models accounted for 15-54% of the variance in follow-up insomnia symptoms. Current findings add to a growing body of literature suggesting anxiety sensitivity may play a causal role in insomnia symptoms. Results also suggest that targeting anxiety sensitivity may be an effective way to reduce insomnia symptoms in a brief and portable intervention that also reduces symptoms commonly comorbid with insomnia disorder.
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Affiliation(s)
| | | | - Savannah King
- Department of Psychology, Florida State University, USA
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21
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Norr AM, Gibby BA, Fuller KL, Portero AK, Schmidt NB. Online Dissemination of the Cognitive Anxiety Sensitivity Treatment (CAST) Using Craigslist: A Pilot Study. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9834-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Sleeping with the enemy: Anxiety regarding the ISIS threat is related to sleep problems. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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23
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Short NA, Boffa JW, Norr AM, Albanese BJ, Allan NP, Schmidt NB. Randomized Clinical Trial Investigating the Effects of an Anxiety Sensitivity Intervention on Posttraumatic Stress Symptoms: A Replication and Extension. J Trauma Stress 2017; 30:296-303. [PMID: 28585746 DOI: 10.1002/jts.22194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/21/2017] [Accepted: 03/01/2017] [Indexed: 11/07/2022]
Abstract
A growing body of research suggests the importance of anxiety sensitivity (AS) in the development and maintenance of posttraumatic stress symptoms (PTSS). Specifically, AS cognitive concerns (fears of cognitive dyscontrol) may be particularly relevant for those with elevated PTSS. Preliminary research has suggested that interventions targeting AS may be beneficial in decreasing PTSS, but to date there has been no randomized controlled trial testing the direct and indirect effects of an AS cognitive concerns intervention among a clinical sample of trauma-exposed individuals. The current study tested these effects among a sample 63 trauma-exposed participants who were randomized to either an AS cognitive concerns intervention or a repeated contact control. Results indicated a direct effect of the intervention on PTSS 1 month postintervention, and that this effect was mediated by changes in AS, specifically AS cognitive concerns, during the intervention period. Effect sizes were in the small-to-medium range (variance accounted for ranged from .05 to .15; odds ratio for diagnostic change = .06). These findings provide further evidence that targeting AS may be beneficial in the treatment of PTSS, and expansion upon this area of research by demonstrating these effects may be specific to AS cognitive concerns and can be achieved within a mixed clinical sample.
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Affiliation(s)
- Nicole A Short
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Joseph W Boffa
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Aaron M Norr
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Brian J Albanese
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | | | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Baker AW, Keshaviah A, Goetter EM, Bui E, Swee M, Rosencrans PL, Simon NM. Examining the Role of Anxiety Sensitivity in Sleep Dysfunction Across Anxiety Disorders. Behav Sleep Med 2017; 15:216-227. [PMID: 26788969 DOI: 10.1080/15402002.2015.1120202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Anxiety Sensitivity (AS) has been associated with sleep difficulties in certain anxiety disorder populations, but no studies have examined cross-diagnostically the role of anxiety sensitivity in sleep dysfunction. Three hundred one participants with generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD) completed an ancillary questionnaire-based study. Linear regression was used to examine AS and sleep dysfunction, and mediation analyses were used to examine whether AS was a mediator of the effect of primary diagnosis on sleep. AS was associated with increased sleep dysfunction across anxiety disorders, and primary anxiety disorder diagnosis was significantly associated with sleep dysfunction. However, after controlling for AS, primary diagnosis was no longer significant. AS significantly mediated the effects of PD versus SAD and of PD versus GAD on sleep dysfunction, but did not significantly mediate the effect of GAD versus SAD on sleep dysfunction. Taken together, AS appears to be a more important predictor of sleep dysfunction overall, emphasizing the cross-diagnostic nature of AS and bolstering the RDoC initiative approach for treating psychological dysfunction.
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Affiliation(s)
- Amanda W Baker
- a Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts.,b Harvard Medical School , Boston , Massachusetts
| | - Aparna Keshaviah
- a Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts.,b Harvard Medical School , Boston , Massachusetts
| | - Elizabeth M Goetter
- a Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts.,b Harvard Medical School , Boston , Massachusetts
| | - Eric Bui
- a Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts.,b Harvard Medical School , Boston , Massachusetts
| | - Michaela Swee
- a Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts
| | - Peter L Rosencrans
- a Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts
| | - Naomi M Simon
- a Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts.,b Harvard Medical School , Boston , Massachusetts
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25
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Anxiety sensitivity and racial differences in sleep duration: Results from a national survey of adults with cardiovascular disease. J Anxiety Disord 2017; 48:102-108. [PMID: 27760717 PMCID: PMC5663191 DOI: 10.1016/j.janxdis.2016.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/22/2022]
Abstract
Although Blacks sleep between 37 and 75min less per night than non-Hispanic Whites, research into what drives racial differences in sleep duration is limited. We examined the association of anxiety sensitivity, a cognitive vulnerability, and race (Blacks vs. White) with short sleep duration (<7h of sleep/night), and whether anxiety sensitivity mediated race differences in sleep duration in a nationally representative sample of adults with cardiovascular disease. Overall, 1289 adults (115 Black, 1174 White) with a self-reported physician/health professional diagnosis of ≥1 myocardial infarction completed an online survey. Weighted multivariable logistic regressions and mediation analyses with bootstrapping and case resampling were conducted. Anxiety sensitivity and Black vs. White race were associated with 4%-84% increased odds, respectively, of short sleep duration. Anxiety sensitivity mediated Black-White differences in sleep duration. Each anxiety sensitivity subscale was also a significant mediator. Implications for future intervention science to address sleep disparities are discussed.
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Grossman ES, Hoffman YSG, Shrira A. Trauma-Related Context Increases Sleep Disturbances in People with Acute Stress Disorder Symptoms. Stress Health 2017; 33:153-157. [PMID: 27062710 DOI: 10.1002/smi.2679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 01/21/2023]
Abstract
In this study, we addressed how sleep is related to acute stress disorder (ASD) symptoms, and how the presence of a trauma related-context moderates this relationship. This study (N = 140) was carried out during the 2014 Israel-Gaza conflict, during which 70% of Israelis were exposed to missile attacks. Findings show that participants with clinical ASD symptom levels reported more sleep disturbances than participants without clinical ASD symptom levels. More critically, this effect was only evident among respondents who had a reinforced security room in their houses. While reinforced security rooms offer protection against indirect missile damage, their relevance is salient in negative traumatic situations, which individuals with a clinical level of ASD are more sensitive to. Conversely, in houses without a reinforced security room, there was no difference in subjective sleep reports between individuals with or without clinical levels of ASD symptoms. Results are discussed in reference to trauma being activated by context and the ensuing effects on sleep. Theoretical and clinical implications are discussed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ephraim S Grossman
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Yaakov S G Hoffman
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Amit Shrira
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
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27
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Norr AM, Gibby BA, Schmidt NB. Is computerized psychoeducation sufficient to reduce anxiety sensitivity in an at-risk sample?: A randomized trial. J Affect Disord 2017; 212:48-55. [PMID: 28142083 DOI: 10.1016/j.jad.2017.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/23/2016] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anxiety sensitivity (AS), or a fear of anxiety-related sensations, has become one of the most well researched risk factors for the development of psychopathology and comprises three subfactors: physical, cognitive, and social concerns. Fortunately, research has demonstrated brief protocols can successfully reduce AS, and in turn improve psychopathological symptoms. Computerized AS reduction protocols have combined psychoeducation with interoceptive exposure (IE), but they have not been dismantled to evaluate the effects of psychoeducation alone. METHOD The current study sought to determine the efficacy of a brief single-session psychoeducation intervention for AS, compared to a control intervention, in a sample of at-risk individuals (N=54) with elevated AS cognitive concerns. RESULTS Individuals in the active condition displayed greater reductions in self-reported AS (β=.198, 95% CI [.065, .331]) and less fear reactivity (β=.278, 95% CI [.069, .487]) to the induction of AS cognitive-relevant sensations through a behavioral challenge compared to those in the control condition. Further, fear reactivity to the challenge was mediated by reductions in self-reported AS cognitive concerns. LIMITATIONS Study limitations include use of an at-risk nonclinical student sample, lack of a long-term follow-up assessment, and inability to discern whether AS reductions due to CAST psychoeducation prevent future, or improve current, psychological symptoms. CONCLUSIONS These results suggest that psychoeducation alone can produce significant AS reduction.
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Affiliation(s)
- Aaron M Norr
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306, USA
| | - Brittany A Gibby
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306, USA.
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28
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Origins and outlook of interoceptive exposure. J Behav Ther Exp Psychiatry 2016; 53:41-51. [PMID: 26596849 DOI: 10.1016/j.jbtep.2015.10.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/11/2015] [Accepted: 10/26/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Interoceptive exposure (IE) is a behavioral intervention that reduces anxiety sensitivity and distress associated with somatic sensations. In this discussion, we describe the history, current applications and additional clinical potential of IE. METHOD We review the origins of IE and its historical application to panic disorder, as well as the accumulating evidence for transdiagnostic application to other disorders including post-traumatic stress disorder, social anxiety disorder, specific phobias and physical disorders. Then, we discuss ways in which IE could contribute to the treatment of additional disorders. RESULTS IE is well-established in the treatment of panic disorder and increasingly used to target anxiety-provoking physical sensations in other disorders. Research and clinical evidence suggests that anxiety sensitivity is present across a range of disorders, and may actually be one variation on a broader phenomenon of interoceptive sensitivity, or anxiety focused on physical sensations that have been conditioned to unpleasant emotional states. Moreover, somatic symptoms are central to the experience of most emotions and may contribute to avoidant coping, a maintenance factor for disorders of emotion. IE has potential as a transdiagnostic intervention targeting interoceptive sensitivity in disorders such as depression and eating disorders. Nevertheless, IE is underutilized by clinicians in practice. Recent research in inhibitory learning and extinction suggests strategies for maximizing the effectiveness of IE. LIMITATIONS This review is not exhaustive in nature, and systematic research on transdiagnostic applications of IE remains scarce. CONCLUSIONS IE is a potentially powerful yet understudied transdiagnostic intervention.
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Otto MW, Eastman A, Lo S, Hearon BA, Bickel WK, Zvolensky M, Smits JAJ, Doan SN. Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion. Clin Psychol Rev 2016; 49:67-78. [PMID: 27611632 DOI: 10.1016/j.cpr.2016.07.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 06/03/2016] [Accepted: 07/25/2016] [Indexed: 11/15/2022]
Abstract
Understanding the nature and influence of specific risk profiles is increasingly important for health behavior promotion. The purpose of this article is to document the value of two factors-anxiety sensitivity (AS) and working memory capacity (WMC)-for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors. AS is a distress-related risk factor that potentiates avoidance/coping motivations for negative health behaviors. Stress provides the conditions for negative somatic and affective states, and AS amplifies the aversiveness of these experiences and correspondingly hinders adaptive functioning. In contrast, low WMC is hypothesized to exert its effect by decreasing the capacity to filter out current temptations, attenuating a focus on longer-term goals and impairing the application of relevant coping skills at times of stress. In this review, we provide conceptual models for the separate roles of high AS and low WMC in negative health behaviors, review the influence of these factors on specific health behavior exemplars (eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep promotion), provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage specific research directions in relation to these variables.
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Affiliation(s)
- Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, USA.
| | - Abraham Eastman
- Department of Psychological and Brain Sciences, Boston University, USA
| | - Stephen Lo
- Department of Psychological and Brain Sciences, Boston University, USA
| | | | - Warren K Bickel
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, USA
| | - Michael Zvolensky
- University of Houston, USA; The University of Texas MD Anderson Cancer Center, USA
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, USA
| | - Stacey N Doan
- Department of Psychology, Claremont McKenna College, USA
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Pillai V, Cheng P, Kalmbach DA, Roehrs T, Roth T, Drake CL. Prevalence and Predictors of Prescription Sleep Aid Use among Individuals with DSM-5 Insomnia: The Role of Hyperarousal. Sleep 2016; 39:825-32. [PMID: 26943472 DOI: 10.5665/sleep.5636] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/17/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Despite mounting evidence for the overuse of prescription sleep aids (PSA), reliable data on PSA use among insomniacs are unavailable. Current studies focus on trends in PSA use at the general population level, and thus do not distinguish between transient sleep disturbance and insomnia disorder. Therefore, we prospectively examined the prevalence and predictors of baseline and chronic PSA use in a well-defined sample of individuals with insomnia. METHODS We analyzed longitudinal data from an urban, community-based cohort of 649 adults (48.1 ± 11.6 y; 69.3% female) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-based insomnia disorder. Participants completed standardized measures of sleep disturbance, daytime alertness, depression, and anxiety at baseline and follow-up 1 y later. They also reported whether and with what frequency they used PSA at both time points. RESULTS Approximately 19% of the sample used PSA at baseline, the majority (69.4%) of whom continued use 1 y later. Anxiety and daytime alertness were the only independent predictors of both acute and chronic PSA use. An increase of 1 standard deviation (SD) in alertness was associated with a 33% increase in the odds of chronic PSA use (χ(2) = 4.98; odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.04-1.72; P < 0.05), and a 1-SD increase in anxiety was associated with a 41% increase (χ(2) = 6.95; OR = 1.41; 95% CI: 1.09-1.82; P < 0.05). Chronic PSA users did not report any significant improvements in sleep from baseline to follow-up relative to nonusers. CONCLUSIONS Hyperarousal, as indexed by daytime alertness and anxiety, is a strong determinant of PSA use among individuals with insomnia. These findings are consistent with emerging data showing that insomnia is not just a nocturnal sleep disorder, but one characterized by 24-h arousal. Though current research targets sleep disturbance, this study highlights the role of the arousal system in pharmacological treatment seeking.
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Affiliation(s)
- Vivek Pillai
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
| | - Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
| | - David A Kalmbach
- Sleep and Circadian Research Laboratory, University of Michigan, Ann Arbor, MI
| | - Timothy Roehrs
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
| | - Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
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Dixon LJ, Lee AA, Viana AG, McCowan NK, Brodell RT, Tull MT. Anxiety Sensitivity in Dermatological Patients. PSYCHOSOMATICS 2016; 57:498-504. [PMID: 27137710 DOI: 10.1016/j.psym.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anxiety symptoms commonly occur in dermatological patients and can affect the severity of dermatological symptoms. Anxiety sensitivity (AS), defined as the fear of anxiety symptoms, is a well-supported cognitive vulnerability factor that may be particularly significant in these patients. OBJECTIVE This study compared the severity of AS between patients with psychodermatological (e.g., psoriasis) and nonpsychodermatological disorders (e.g., skin cancer). It was predicted that individuals with psychodermatological disorders would evidence significantly greater AS compared to individuals with nonpsychodermatological disorders. METHOD Adults presenting to outpatient dermatology clinics with psychodermatological (n = 63) and nonpsychodermatological (n = 52) conditions completed self-report questionnaires assessing sociodemographic characteristics, general anxiety, and AS. RESULTS Individuals with psychodermatological conditions reported significantly greater AS compared to individuals with nonpsychodermatological conditions (p < 0.05). Social concerns of AS emerged as the only significant factor that differentiated these categories of dermatological diseases, odds ratio = 1.13, 95% CI: 1.02-1.24, after adjusting for general anxiety. CONCLUSIONS These findings contribute to an advancing area of research linking AS and physical health problems. The results suggest that adjunctive cognitive-behavioral treatments targeting AS reductions could help patients with psychodermatological conditions.
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Affiliation(s)
- Laura J Dixon
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS.
| | - Aaron A Lee
- Department of Psychology, University of Wyoming, Laramie, WY
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX
| | - Nancye K McCowan
- Department of Dermatology, University of Mississippi Medical Center, Jackson, MS
| | - Robert T Brodell
- Department of Dermatology, University of Mississippi Medical Center, Jackson, MS
| | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
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Abstract
Anxiety is adaptive and plays an important role in keeping us safe. However, when anxiety becomes too extreme, it can cause significant disruptions and distress. Understanding the mechanisms underlying excessive anxiety and how to best treat it is a priority for researchers and clinicians. There is increasing recognition that disruptions in the amount and timing of sleep are associated with anxiety symptoms and characteristics. In the current paper, we explore the intersections between sleep, circadian rhythms, and anxiety. First, we review accumulating evidence that anxiety is associated with disruptions in sleep and circadian rhythms in both clinical and nonclinical samples and across ages. Next, we discuss the data linking sleep disruptions with anxiety-related traits (anxiety sensitivity, neuroticism, and perfectionism) and patterns of cognition and emotion. Finally, potential treatment implications are highlighted. Overall, these data suggest that delineating the role of disruptions in the amount and timing of sleep holds promise for improving the lives of individuals with heightened anxiety.
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