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Wright LJ, Veldhuijzen van Zanten JJCS, Williams SE. Examining the associations between physical activity, self-esteem, perceived stress, and internalizing symptoms among older adolescents. J Adolesc 2023; 95:1274-1287. [PMID: 37248071 DOI: 10.1002/jad.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION In older adolescence, stress has been found to be prevalent. It has been seen that higher physical activity (PA) relates to lower stress levels, which, in turn, relates to fewer anxiety and depressive symptoms (internalizing symptoms). However, how these associations function is not fully understood. PA is strongly associated with greater self-esteem in adolescents. As greater self-esteem is thought to aid better coping with stress and has been seen as beneficial for mental health in adolescents, PA may be associated with lower stress and better mental health through self-esteem and more adaptive stress appraisals. Therefore, the aim of the study was to examine the relationships between PA, self-esteem, stress, and mental health. METHODS A cross-sectional design was employed, and path analysis was implemented. PA, self-esteem, stress appraisals, distress tolerance, perceived stress, anxiety, and depression were assessed using online questionnaires from 244 adolescent participants from the United Kingdom (aged 15-19, M = 16.75 [SD = 0.82], 145 female). RESULTS Path analysis revealed that PA was associated with lower perceived stress through increased self-esteem, adaptive appraisals, and higher distress tolerance (total standardized indirect effect; p = .007 (-0.25 to -0.11). Moreover, lower perceived stress was associated with lower anxiety (standardized direct effect; p < .001 [2.65-4.0] and depressive symptoms (standardized direct effect; p < .001 [0.33-0.63]). CONCLUSIONS Findings suggest that higher PA could be effective in improving mental health among older adolescents, due to its association with perceived stress through higher self-esteem and more adaptive appraisals of stress.
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Affiliation(s)
- Laura J Wright
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Sarah E Williams
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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2
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Wolitzky-Taylor K, Smit T, Vujanovic AA, Zvolensky MJ. Transdiagnostic Processes Linking Posttraumatic Stress Disorder Symptoms to Alcohol Use Severity. J Dual Diagn 2023; 19:97-110. [PMID: 37389859 DOI: 10.1080/15504263.2023.2225373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, California, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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3
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Mattingley S, Youssef GJ, Manning V, Graeme L, Hall K. Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis. J Affect Disord 2022; 300:492-504. [PMID: 34986376 DOI: 10.1016/j.jad.2021.12.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/08/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distress tolerance (DT) has received increased attention in recent years due to its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology. METHODS A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, and BPD symptomatology. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender. RESULTS DT shared significant, negative, medium correlations with PSU (r = -.18,), DEB (r = -.20), and BPD symptomatology (r = -.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships. LIMITATIONS The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures. CONCLUSIONS The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.
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Affiliation(s)
| | - George J Youssef
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre (MARC), Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia
| | - Liam Graeme
- Deakin University, Geelong, Australia, School of Psychology
| | - Kate Hall
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
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4
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Targeting maladaptive reactivity to negative affect in emerging adults with cannabis use disorder: A preliminary test and proof of concept. Behav Res Ther 2022; 150:104032. [DOI: 10.1016/j.brat.2022.104032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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5
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Kechter A, Barrington-Trimis JL, Cho J, Davis JP, Huh J, Black DS, Leventhal AM. Distress tolerance and subsequent substance use throughout high school. Addict Behav 2021; 120:106983. [PMID: 34010760 DOI: 10.1016/j.addbeh.2021.106983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the association of perceived distress tolerance-one's ability to endure aversive experiences-with subsequent substance use frequency during adolescence. METHODS High school students (N = 3,203) were surveyed semiannually from 2013 to 2017. The Distress Tolerance Scale (DTS) was administered at baseline (9th grade) and self-reported past 30-day number of days used of alcohol, cigarettes, e-cigarettes, cannabis, and opioids (range: 0-30) were assessed at all timepoints. Self-reported baseline ever (vs. never) use of each substance and depressive/anxiety symptom status (clinical and subclinical vs. none) were tested as moderators. RESULTS Among baseline never substance users, a greater baseline mean DTS score was associated with fewer days of alcohol, cigarette, and opioid use in past-30 days over 4 years of follow-up (IRR range = 0.60-0.84); among ever-users, baseline mean DTS was not significantly associated with substance use across follow-up timepoints (p-interaction = 0.03). The association of DTS and frequency of substance use did not differ by baseline mental health status for any substance (all ps > 0.05). CONCLUSIONS Greater perceived distress tolerance at the start of high school may be a protective factor against substance use frequency prior to initial use. Interventions that build distress tolerance in early adolescence may be warranted to prevent higher frequency substance use throughout high school.
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6
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Wolitzky-Taylor K, Sewart A, Zinbarg R, Mineka S, Craske MG. Rumination and worry as putative mediators explaining the association between emotional disorders and alcohol use disorder in a longitudinal study. Addict Behav 2021; 119:106915. [PMID: 33770722 DOI: 10.1016/j.addbeh.2021.106915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The high rate of comorbidity between alcohol use and emotional disorders is well demonstrated, but the mechanisms underlying their relationship remain largely unidentified. One possibility is maladaptive responding to negative affect, such as worry and rumination. The present study sought to examine worry and rumination as putative mediators explaining the link between emotional disorders and alcohol use disorders. Methods Mediational analyses were conducted using a sample (n = 232) derived from a larger late adolescence/early adulthood longitudinal dataset (Youth Emotion Project; Zinbarg et al., 2010). Results A significant indirect effect was observed for emotional disorder severity on alcohol use disorder severity via rumination, but not via worry or the shared variance between worry and rumination. Conclusions These findings suggest that rumination may specifically confer risk for the development of alcohol use disorder for individuals with emotional disorders. Further, ruminative thinking may serve as a specific treatment target to reduce vulnerability to alcohol use disorder.
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Affiliation(s)
- Kate Wolitzky-Taylor
- University of California - Los Angeles, Department of Psychiatry and Biobehavioral Sciences, USA.
| | - Amy Sewart
- California State University - Dominguez Hills, Department of Psychology, USA.
| | | | - Susan Mineka
- Northwestern University, Department of Psychology, USA
| | - Michelle G Craske
- University of California - Los Angeles, Department of Psychology, USA.
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Knapp AA, Allan NP, Cloutier R, Blumenthal H, Moradi S, Budney AJ, Lord SE. Effects of anxiety sensitivity on cannabis, alcohol, and nicotine use among adolescents: evaluating pathways through anxiety, withdrawal symptoms, and coping motives. J Behav Med 2021; 44:187-201. [PMID: 32980966 PMCID: PMC7965231 DOI: 10.1007/s10865-020-00182-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/05/2020] [Indexed: 12/14/2022]
Abstract
Anxiety sensitivity (AS) is a promising intervention target due to its relevance to negative health behaviors broadly, and substance use specifically. The aim of the current study was to evaluate the direct and indirect pathways through which elevated AS could relate to recent substance use among a national adolescent sample recruited via social-media. As predicted, AS was indirectly associated with greater likelihood of using alcohol, cigarettes, and electronic nicotine delivery systems in the past-month through anxiety symptoms. Regarding cannabis, AS was directly related to increased likelihood of past-month cannabis use; however, the indirect relation between AS and likelihood of past-month use via anxiety symptoms was not significant. Through chained indirect effects, AS was related positively to past-month alcohol and cannabis use via anxiety symptoms and coping-related motives, and through withdrawal symptoms and coping-related motives. Study findings can be used to generate hypotheses on potential pathways through which AS could prospectively relate to substance use among youth.
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Affiliation(s)
- Ashley A Knapp
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr. 10th Floor, Chicago, IL, 60611, USA.
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA
| | - Renee Cloutier
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Heidemarie Blumenthal
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Shahrzad Moradi
- Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA
| | - Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA
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Lebeaut A, Zegel M, Leonard SJ, Bartlett BA, Vujanovic AA. Examining Transdiagnostic Factors among Firefighters in Relation to Trauma Exposure, Probable PTSD, and Probable Alcohol Use Disorder. J Dual Diagn 2021; 17:52-63. [PMID: 33308060 DOI: 10.1080/15504263.2020.1854411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Firefighters represent a distinct group of first responders that are at heightened risk of developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Assessing the role of transdiagnostic factors that underlie PTSD-AUD associations can inform specialized interventions among this population. This study included urban firefighters (N = 657) with probable PTSD-AUD (n = 27), probable PTSD-alone (n = 35), probable AUD-alone (n = 125), and trauma-exposure-only (n = 470). Methods: All firefighters completed a self-report, online questionnaire battery. Between group differences in anxiety sensitivity (AS), distress tolerance (DT), mindfulness, and emotional regulation difficulties (ERD) were assessed. It was hypothesized that firefighters with probable PTSD-AUD would endorse elevated AS and ERD, and reduced DT and mindfulness in comparison to all other diagnostic groups. Relationship status was included as a covariate in all comparisons. Results: Firefighters with probable PTSD-AUD endorsed elevated AS and ERD, and reduced DT and mindfulness in comparison to firefighters with trauma-exposure-only and probable AUD-alone. Firefighters with probable PTSD-AUD and probable PTSD-alone did not significantly differ. Conclusions: Given these findings, this line of inquiry has great potential to inform specialized, evidence-based mental health programming among firefighter populations, who represent a unique population susceptible to trauma-exposure, PTSD symptomology, and problematic alcohol use.
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Affiliation(s)
- Antoine Lebeaut
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Maya Zegel
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Samuel J Leonard
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Brooke A Bartlett
- Department of Psychology, University of Houston, Houston, TX, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, TX, USA
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9
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Hernandez Rodriguez J, Gregus SJ, Craig JT, Pastrana FA, Cavell TA. Anxiety Sensitivity and Children's Risk for Both Internalizing Problems and Peer Victimization Experiences. Child Psychiatry Hum Dev 2020; 51:174-186. [PMID: 31401756 DOI: 10.1007/s10578-019-00919-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this study, we examined the degree to which children's level of anxiety sensitivity (AS) was a precursor to both internalizing problems and peer victimization experiences. Participants were 581 fourth-grade children (M age = 9.31; 51.8% girls; 42.3% Hispanic/Latinx) and their teachers. Measures of AS, internalizing problems, and peer victimization were collected across a single academic year (Fall, Spring). Structural equation modeling and logistic regression analyses indicated AS predicted future internalizing symptoms as well as self- and teacher-reports of peer victimization. Also, children with heightened AS were 2.70 times more likely to reach elevated levels of self-rated peer victimization and 11.53 times more likely to have clinically elevated internalizing problems. This is the first study to examine prospectively the link between AS and children's peer victimization experiences. We discuss implications of the findings for developing preventative interventions for children at risk for peer victimization and internalizing difficulties.
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Affiliation(s)
| | - Samantha J Gregus
- Department of Psychology, Wichita State University, Wichita, KS, USA
| | - James T Craig
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, NH, USA
| | - Freddie A Pastrana
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy A Cavell
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
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10
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Yaacoub H, Haddad C, Dib T, Zoghbi M, Assaad S, Obeid S, Sacre H, Hallit S, Kazour F. Posttraumatic stress disorders and depression among male inpatient adults involved in the Lebanese war. Perspect Psychiatr Care 2020; 56:263-269. [PMID: 31318076 DOI: 10.1111/ppc.12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/10/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE to evaluate factors associated with posttraumatic stress disorder (PTSD) and depression in a sample of hospitalized Lebanese adult males who directly or indirectly were involved in armed conflicts. DESIGN Cross-sectional. METHODS Seventy-seven hospitalized males were enrolled between June and December 2016. The Hamilton Anxiety and Depression Scale and the Mini International Neuropsychiatric Interview were used to assess anxiety, depression, and PTSD. RESULTS Participation in war (adjusted odds ratio [ORa] = 6.35) and depression (ORa = 1.08) were associated with higher PTSD, whereas age (ORa = 0.94) and substance use (ORa = 0.19) were associated with lower PTSD. Anxiety (β = .87), substance use (β = 6.27) and PTSD (β = 8.78; P = .008) were associated with higher depression. PRACTICE IMPLICATIONS People who experienced war conflicts (directly or indirectly) are more prone to suffer from mental health disorders.
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Affiliation(s)
- Hiba Yaacoub
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Chadia Haddad
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Tania Dib
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Shafika Assaad
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Sahar Obeid
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Pedagogy, Lebanese University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Francois Kazour
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Pedagogy, Lebanese University, Beirut, Lebanon.,INSERM U930, équipe 4 "Troubles Affectifs", Université François-Rabelais de Tours, Parc de Grandmont, Tours, France
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11
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Kelly ME, Guillot CR, Quinn EN, Lucke HR, Bello MS, Pang RD, Leventhal AM. Anxiety sensitivity in relation to cigarette smoking and other substance use in African American smokers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:669-679. [PMID: 32162964 DOI: 10.1037/adb0000573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anxiety sensitivity (AS)-fearfulness of anxiety symptoms-has been implicated in the etiology of emotional disorders (e.g., depressive and anxiety disorders) and linked to cigarette smoking and other substance use (SU). However, studies examining AS in relation to SU primarily have been conducted with racially/ethnically heterogeneous or mostly European American samples. Hence, this cross-sectional study involving secondary analysis of baseline data focused on investigating associations of AS with cigarette smoking and other SU in a sample of 630 non-treatment-seeking African American smokers (37.3% female; M age = 49.6 years; M cigarettes smoked per day = 15.4). After screening out individuals with non-nicotine substance dependence, participants reported their demographics, AS, dysphoria symptoms (i.e., depression and anxiety symptoms), and SU. In regression analyses controlling for dysphoria symptoms, age, education level, income level, and years of regular smoking, AS was positively associated with tobacco withdrawal severity (β = .12, p = .007), overall smoking motives (β = .17, p < .001), alcohol use problems (β = .12, p = .005), and other (non-nicotine, nonalcohol) SU problems (β = .16, p < .001). Though lacking the passage of time between assessments needed to provide strong evidence of mediation, unplanned analyses further revealed indirect associations of AS with several SU variables through dysphoria symptoms. Current findings are consistent with those found in prior samples and suggest that AS is similarly related to SU in African Americans, who may benefit from interventions that have been helpful in improving AS, dysphoria symptoms, and SU in other groups. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Mariel S Bello
- Department of Psychology, University of Southern California
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
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12
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Guillot CR, Blackledge SM, Douglas ME, Cloutier RM, Liautaud MM, Pang RD, Kirkpatrick MG, Leventhal AM. Indirect Associations of Anxiety Sensitivity with Tobacco, Alcohol, and Other Drug Use Problems Through Emotional Disorder Symptoms in Adolescents. Behav Med 2020; 46:161-169. [PMID: 31039083 PMCID: PMC6821558 DOI: 10.1080/08964289.2019.1573797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Theoretically, anxiety sensitivity-fear of anxiety symptoms-enhances perception of and emotional reactivity to autonomic arousal and mental distress, thereby increasing negative affect and motivation to use substances for negative reinforcement. Because no prior study of adolescents has tested if anxiety sensitivity is indirectly associated with substance use problems through symptoms of emotional disorders (i.e., disorders involving high levels of negative affect), the current cross-sectional study examined this theoretical pathway. Participants included ninth-grade students from 10 different high schools in the Los Angeles metropolitan area (N = 3005; 54.3% female). Self-report measures of anxiety sensitivity, emotional disorder symptoms, tobacco dependence, and alcohol and other drug problems were administered. Controlling for sex, race/ethnicity, parental education, school, and impulsiveness, we tested the associations of anxiety sensitivity with tobacco, alcohol, and other drug use problems as well as the indirect effects of anxiety sensitivity on each domain of substance use problems through emotional disorder symptoms. Anxiety sensitivity was associated with more severe tobacco dependence and greater alcohol problems and other drug problems, and anxiety sensitivity further was indirectly associated with all three domains of substance use problems through emotional disorder symptoms. Current findings suggest that adolescents high in anxiety sensitivity tend to experience emotional disorder symptoms, which may increase risk for substance use problems. Interventions that target anxiety sensitivity and enhance negative-affect coping skills may assist in preventing and reducing adolescent substance use problems.
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Affiliation(s)
- Casey R. Guillot
- Department of Psychology, University of North Texas, Denton, TX,Corresponding author: Casey Guillot, PhD, University of North Texas, Department of Psychology, 1155 Union Circle #311280, Denton, TX 76203-5017; Tel: 1-940-369-8426; Fax: 1-940-565-4682;
| | - Sabrina M. Blackledge
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | | | | | - Madalyn M. Liautaud
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Raina D. Pang
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | | | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA,Department of Psychology, University of California, Los Angeles, CA
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13
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Bilsky SA, Cloutier RM, Guillot CR, Bynion TM, Lewis SF. Relations Between Parental Distress Intolerance, Adolescent Motives for Cigarette Use, and Adolescent Cigarette Smoking Levels. Subst Use Misuse 2019; 54:2207-2217. [PMID: 31299868 PMCID: PMC6849207 DOI: 10.1080/10826084.2019.1638937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A relatively large body of evidence indicates that coping motives for cigarette smoking are associated with a number of problematic outcomes (e.g., greater smoking frequency) among adolescents. Evidence also indicates that lower distress tolerance (or higher distress intolerance) is related to higher levels of coping motives for cigarette smoking among adults and adolescents. Therefore, it is critical to improve our understanding of factors that may increase the likelihood of smoking to cope among adolescents. In addition, evidence suggests that a number of parenting behaviors may affect adolescent smoking behavior. No work to date, however, has examined the relation between parental distress intolerance and adolescent smoking motives, or adolescent smoking behavior. Objective/methods: The current study involving adolescents (n = 46) and one of their parents aimed to address this gap in the literature by examining the association between parent-reported parental distress intolerance, self-reported adolescent motives for cigarette use, and self-reported adolescent cigarette smoking levels. Results: Results indicated that parental distress intolerance was related to greater adolescent coping motives for cigarette smoking, but not to other motives for adolescent cigarette use. Furthermore, results indicated that parental distress intolerance was indirectly associated with higher adolescent cigarette smoking levels through adolescent coping motives for cigarette smoking. Conclusions: Parental distress intolerance is associated with coping motives for adolescent cigarette smoking. This suggests parental emotional factors may be associated with adolescent cigarette use.
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Affiliation(s)
- Sarah A. Bilsky
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Renee M. Cloutier
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Casey R. Guillot
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Teah M. Bynion
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Sarah F. Lewis
- Center for Research, Assessment, and Treatment Efficacy (CReATE), Asheville, NC, USA
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Kechter A, Leventhal AM. Longitudinal Association of Sleep Problems and Distress Tolerance During Adolescence. Behav Med 2019; 45:240-248. [PMID: 30358501 PMCID: PMC6483882 DOI: 10.1080/08964289.2018.1514362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/05/2018] [Accepted: 08/13/2018] [Indexed: 02/04/2023]
Abstract
The mechanism by which sleep problems adversely impacts adolescent health is poorly understood. Distress tolerance-a multifactorial trait indicative of one's ability to withstand negative emotions and persist toward long-term goals-is implicated in numerous emotional psychopathologies and an important target for research and practice. We hypothesized that the adverse psychobiological effects of sleep problems could disrupt the development of distress tolerance during adolescence. This longitudinal study examined whether sleep problems predicted changes in four facets of distress tolerance during adolescence: (1) absorption-feeling attention is captured by negative emotions, (2) appraisal-experiencing distress as unacceptable, (3) regulation-engaging in behaviors to terminate distress, and (4) tolerance-low perceived ability to tolerate distress. High school students (M baseline age = 15.5 years, N = 2,309, 56.1% female), completed self-report measures of sleep problems and distress tolerance at baseline and 1-year follow-up. In linear regression models adjusting for baseline distress tolerance, sleep problems predicted poorer distress tolerance at 1-year follow-up for each distress tolerance facet (βs = -0.10 to -0.24, ps ≤ 0.02). After additionally controlling for sociodemographics and emotional psychopathology, sleep problems were associated with poorer distress tolerance for absorption (β = -0.13, p = 0.004) and appraisal (β = -0.09, p = 0.049) facets, but not regulation or tolerance (ps ≥ 0.35) facets. Interventions targeting healthy sleep habits warrant consideration for improving adolescent development of certain facets of distress tolerance, and in turn various positive health outcomes improved by distress tolerance.
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Affiliation(s)
- Afton Kechter
- a Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles , California , USA
| | - Adam M Leventhal
- a Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles , California , USA
- b Department of Psychology, University of Southern California , Los Angeles , California , USA
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15
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Qi J, Rappaport LM, Cecilione J, Hettema JM, Roberson-Nay R. Differential Associations of Distress Tolerance and Anxiety Sensitivity With Adolescent Internalizing Psychopathology. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 50:97-104. [PMID: 31059291 DOI: 10.1080/15374416.2019.1602838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Distress tolerance and anxiety sensitivity may differentiate among internalizing disorders, though few studies have examined differential associations of distress tolerance and anxiety sensitivity with depression and anxiety symptoms while adjusting for their intercorrelation. In an adolescent genetic epidemiological sample (ages 15-21), the present study (N = 848, 56.97% female) examined concurrent associations of distress tolerance and anxiety sensitivity with internalizing psychopathology (i.e., symptoms of depression, anxiety, and general stress) at baseline and prospective, predictive associations of baseline distress tolerance and anxiety sensitivity with internalizing psychopathology at 2-year follow-up. In addition, the present study assessed distress tolerance with two laboratory-based tasks, a carbon dioxide challenge and the mirror-tracing task, to distinguish between tolerance of physiological and cognitive distress, respectively. Elevated anxiety sensitivity was broadly associated with elevated symptoms of internalizing psychopathology at baseline and prospectively predicted elevated depression, anxiety, and stress symptoms at 2-year follow-up. Higher tolerance of cognitive distress was associated with lower concurrent anxiety symptoms but not with anxiety symptoms at follow-up. The present results clarify previously mixed findings; during adolescence, anxiety sensitivity showed broad concurrent and prospective associations with internalizing disorder risk whereas distress tolerance, specifically regarding cognitive distress, was associated with only elevated concurrent anxiety symptoms.
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Affiliation(s)
- Jun Qi
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Lance M Rappaport
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University.,Department of Psychology, University of Windsor
| | - Jennifer Cecilione
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - John M Hettema
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Roxann Roberson-Nay
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
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16
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Alcohol expectancies and distress tolerance: Potential mechanisms in the relationship between posttraumatic stress and alcohol use. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Jacquart J, Dutcher CD, Freeman SZ, Stein AT, Dinh M, Carl E, Smits JAJ. The effects of exercise on transdiagnostic treatment targets: A meta-analytic review. Behav Res Ther 2018; 115:19-37. [PMID: 30473437 DOI: 10.1016/j.brat.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present study meta-analytically reviewed the effects of exercise on four transdiagnostic treatment targets: anxiety sensitivity (AS), distress tolerance (DT), stress reactivity (SR), and general self-efficacy (GSE). METHODS We conducted systematic searches of peer-reviewed studies in bibliographical databases (Cochrane Library, psychINFO, PubMed) before April 1, 2018. Only randomized controlled trials (RCT) evaluating the effect of exercise on AS, DT, SR, or GSE using at least one validated outcome instrument in a sample of adolescents (≥13 years old) or adults were selected. We employed a meta-analysis of effects using random-effects pooling modeling for each treatment target. RESULTS The systematic search yielded 28 RCTs meeting eligibility criteria. Exercise interventions had a large effect on reducing AS (six studies, Hedges's g = 0.72, p = .001), a medium effect on increasing GSE (eight studies, Hedges's g = 0.59, p < .001), and a small effect on reducing SR (ten studies, Hedges's g = 0.32, p < .001). Evidence from four studies suggested that exercise interventions had a small but non-significant effect on increasing DT (Hedges's g = 0.21, p = .26). CONCLUSIONS This meta-analysis provides preliminary evidence exercise can engage certain transdiagnostic targets. Further research is required to optimize exercise intervention parameters to achieve the strongest effects on these important mechanistic variables.
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Affiliation(s)
- Jolene Jacquart
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA.
| | - Christina D Dutcher
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Slaton Z Freeman
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Aliza T Stein
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Mike Dinh
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Emily Carl
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
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18
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Overstreet C, Brown E, Berenz EC, Brown RC, Hawn S, McDonald S, Pickett T, Danielson CK, Thomas S, Amstadter A. Anxiety Sensitivity and Distress Tolerance Typologies and Relations to Posttraumatic Stress Disorder: A Cluster Analytic Approach. MILITARY PSYCHOLOGY 2018; 30:547-556. [PMID: 30886457 DOI: 10.1080/08995605.2018.1521682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A growing literature suggests a relationship between a high anxiety sensitivity (AS; the fear of anxiety and its related consequences)/low distress tolerance (DT; the capacity tolerate internal negative states) profile and posttraumatic stress disorder (PTSD) symptoms. However, specific profiles have not been identified or examined specifically in veteran samples. Thus, the aims of the present study were to establish empirically derived profiles created from response patterns on the Anxiety Sensitivity Index and Distress Tolerance Scale and to examine associations with PTSD symptom clusters among a sample of combat-exposed veterans (N = 250). A cluster analytic approach was utilized to identify AS/DT profiles, and a series of MANOVAs with post hoc analyses was conducted to examine the relationship between each AS/DT profile and each PTSD symptom cluster. Results indicated a three-cluster solution including a high AS/low DT "at risk" profile, a low AS/high DT "resilient" profile, and an average AS/DT "intermediate" profile. The at-risk profile was associated with significantly greater symptoms in each PTSD cluster (i.e., hyperarousal, avoidance, re-experiencing) when compared to the other two profiles. The at-risk profile was also associated with greater depressive symptoms and lower self-reported resilience. These findings extend the previous literature by identifying a high AS/low DT "at risk" profile and its associations with PTSD symptoms, underscoring the potential utility in targeting these affect-regulation constructs for clinical intervention.
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Affiliation(s)
- Cassie Overstreet
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Emily Brown
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Erin C Berenz
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.,Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ruth C Brown
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Sage Hawn
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Suzanne Thomas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ananda Amstadter
- Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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19
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Wolitzky-Taylor K, Drazdowski TK, Niles A, Roy-Byrne P, Ries R, Rawson R, Craske MG. Change in anxiety sensitivity and substance use coping motives as putative mediators of treatment efficacy among substance users. Behav Res Ther 2018; 107:34-41. [PMID: 29852309 PMCID: PMC10980288 DOI: 10.1016/j.brat.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Anxiety sensitivity and coping motives for substance use are processes implicated in anxiety and substance use disorder (SUD) comorbidity, and are malleable treatment targets. Little is known about whether changes in anxiety sensitivity or coping motives during cognitive behavioral therapy (CBT) for anxiety disorders (with or without CBT for SUD) mediate substance use outcomes among patients with comorbid anxiety disorders and SUD. We examined whether changes in anxiety sensitivity and coping motives during treatment for comorbid SUD and anxiety disorders (either CBT for SUD only or CBT for SUD and anxiety disorders) were associated with substance use outcomes. METHODS Repeated measurements of anxiety sensitivity and coping motives throughout treatment were examined from a randomized clinical trial comparing usual, CBT-based treatment at a substance use disorder specialty clinic (UC) to that usual care plus a brief CBT for anxiety program for patients with comorbid anxiety and substance use disorders (CALM ARC). RESULTS Anxiety sensitivity decline during treatment was significantly steeper among those who received CALM ARC than those in UC. Decreases in anxiety sensitivity mediated the effect of treatment group on alcohol use following treatment such that the greater reduction in anxiety sensitivity in CALM ARC explained the superior outcomes for alcohol use in CALM ARC compared to UC. Declines in substance use coping motives were not observed in either condition, and did not differ between CALM ARC and UC. Thus, declines in coping motives did not mediate substance use after treatment. CONCLUSIONS These findings provide preliminary evidence suggesting alcohol use outcomes were related to decreasing anxiety sensitivity rather than decreasing coping motives. Implications and future directions are discussed.
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20
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Wolitzky-Taylor K, Niles AN, Ries R, Krull JL, Rawson R, Roy-Byrne P, Craske M. Who needs more than standard care? Treatment moderators in a randomized clinical trial comparing addiction treatment alone to addiction treatment plus anxiety disorder treatment for comorbid anxiety and substance use disorders. Behav Res Ther 2018; 107:1-9. [DOI: 10.1016/j.brat.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
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21
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Borges AM, Lejuez CW, Felton JW. Positive alcohol use expectancies moderate the association between anxiety sensitivity and alcohol use across adolescence. Drug Alcohol Depend 2018; 187:179-184. [PMID: 29677626 PMCID: PMC5959789 DOI: 10.1016/j.drugalcdep.2018.02.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/25/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
Anxiety sensitivity (AS), or the fear of anxious symptoms and the belief that these symptoms may have negative physical, social, and cognitive consequences, is one personality trait that emerges in early adolescence and may be linked to alcohol use. However, findings are equivocal as to whether elevated AS during adolescence directly predicts alcohol use. Adolescents do report increases in positive alcohol use expectancies during this developmental period, and these expectancies have been found to be significantly associated with alcohol use. The current study examined whether positive alcohol use expectancies and AS in early adolescence predicted changes in alcohol use throughout adolescence. This aim was examined via secondary data analyses from a longitudinal study examining the development of risk behaviors in adolescents. Results of univariate latent growth curve modeling suggest that AS alone was not a significant predictor of baseline alcohol use or change in use over time after controlling for gender, age, and self-reported anxiety. However, AS in early adolescence was found to be a significant predictor of increases in alcohol use across adolescence for youth who reported greater positive alcohol use expectancies. These results indicate that beliefs regarding the positive effects of alcohol use are an important moderator in the relation between AS and change in alcohol use during adolescence.
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Affiliation(s)
- Allison M. Borges
- Department of Psychology, Rutgers University, New Brunswick, 152 Frelinghuysen Rd., Piscataway Township, NJ 08854, USA
| | - Carl W. Lejuez
- University of Kansas, College of Liberal Arts and Sciences, 1450 Jayhawk Blvd., #200, Lawrence, KS 66045, USA
| | - Julia W. Felton
- Department of Psychology, University of Maryland, College Park, 4094 Campus Dr., College Park, MD 20742, USA
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22
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Leventhal AM, Cho J, Stone MD, Barrington-Trimis JL, Chou CP, Sussman SY, Riggs NR, Unger JB, Audrain-McGovern J, Strong DR. Associations between anhedonia and marijuana use escalation across mid-adolescence. Addiction 2017; 112. [PMID: 28623880 PMCID: PMC5673572 DOI: 10.1111/add.13912] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Anhedonia-a transdiagnostic psychopathological trait indicative of inability to experience pleasure-could lead to and result from adolescent marijuana use, yet this notion has not been tested. This study aimed to estimate the association of: (1) anhedonia at age 14 with rate of change in marijuana use over an 18-month follow-up, and (2) marijuana use at age 14 with rate of change in anhedonia over follow-up. Secondary aims were to test whether gender, baseline marijuana use history and peer marijuana use moderated these associations. DESIGN Observational longitudinal cohort repeated-measures design, with baseline (age 14 years), 6-month, 12-month and 18-month follow-up assessments. SETTINGS Ten public high schools in Los Angeles, CA, USA, 2013-15. PARTICIPANTS Students [n = 3394; 53.5% female, mean (standard deviation) age at baseline = 14.1 (0.42)]. MEASUREMENTS Self-report level of anhedonia on the Snaith-Hamilton Pleasure Scale and frequency of marijuana use in the past 30 days. FINDINGS Parallel process latent growth curve models adjusting for confounders showed that baseline anhedonia level was associated positively with the rate of increase in marijuana use frequency across follow-ups [β, 95% confidence interval (CI) = 0.115 (0.022, 0.252), P = 0.03]. Baseline marijuana use frequency was not related significantly to the rate of change in anhedonia across follow-ups [β, 95% CI = -0.015 (-0.350, 0.321), P = 0.93]. The association of baseline anhedonia with faster marijuana use escalation was amplified among adolescents with (versus without) friends who used marijuana at baseline [β, 95% CI = 0.179 (0.043, 0.334) versus 0.064 (-0.071, 0.187), interaction P = 0.04], but did not differ by gender or baseline ever marijuana use. CONCLUSIONS In mid-adolescence, anhedonia is associated with subsequent marijuana use escalation, but marijuana use escalation does not appear to be associated with subsequent anhedonia.
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Affiliation(s)
- Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA,Department of Psychology, University of Southern California, Los Angeles, CA,Corresponding author: Adam M. Leventhal, Ph.D., University of Southern California, Keck School of Medicine, 2250 Alcazar St. CSC 271, Los Angeles, CA 90033, USA; , Phone: 323-442-8222, Fax: 323-442-2359
| | - Junhan Cho
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Matthew D. Stone
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | | | - Chih-Ping Chou
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA,School of Social Work, University of Southern California, Los Angeles, CA
| | - Steven Y. Sussman
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA,Department of Psychology, University of Southern California, Los Angeles, CA,School of Social Work, University of Southern California, Los Angeles, CA
| | - Nathaniel, R. Riggs
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO
| | - Jennifer B. Unger
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Janet Audrain-McGovern
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - David R. Strong
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, CA
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Felton JW, Banducci AN, Shadur JM, Stadnik R, MacPherson L, Lejuez CW. The developmental trajectory of perceived stress mediates the relations between distress tolerance and internalizing symptoms among youth. Dev Psychopathol 2017; 29:1391-1401. [PMID: 28318473 PMCID: PMC6360527 DOI: 10.1017/s0954579417000335] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The current study examines the relation between distress tolerance, perceived stress, and internalizing symptoms across adolescence. Participants included 331 youth, ages 10 to 14 at the first wave of the study, assessed annually over 5 years. A latent growth curve approach was used to test three research questions, including whether perceived stress would increase across adolescence, whether distress tolerance (as measured by a behavioral task) would predict changes in perceived stress, and whether changes in perceived stress would mediate the relation between distress tolerance and internalizing symptoms. Results suggest that, consistent with previous findings, rates of perceived stress do increase across adolescence. Further, findings indicate that distress intolerance at baseline predicted increases in perceived stress, which in turn drove increases in internalizing symptoms. These findings point to the critical role of distress tolerance in bringing about changes in depression and anxiety symptoms and suggest support for utilizing a negative reinforcement framework to understand the emergence of internalizing symptomology.
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24
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Associations of anxiety sensitivity and emotional symptoms with the subjective effects of alcohol, cigarettes, and cannabis in adolescents. Addict Behav 2017; 73:192-198. [PMID: 28544955 DOI: 10.1016/j.addbeh.2017.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 12/26/2022]
Abstract
Maladaptive emotional traits (anxiety sensitivity [AS], fear of anxiety-related sensations and consequences) and symptoms (major depressive disorder [MDD] and generalized anxiety disorder [GAD] symptoms) could play a role in altering sensitivity to the subjective effects of drugs of abuse in adolescents. Data were drawn from a longitudinal study of high school students in Los Angeles, CA, USA who completed surveys and reported past six-month use of alcohol (n=1054), cigarettes (n=297), or cannabis (n=706). At each of the four semi-annual waves during mid-adolescence (14-16years old), students reported positive and negative subjective drug effects experienced in the prior six-months. Controlling for covariates and the simultaneous covariance across the three domains of emotional dysfunction, AS was associated with more positive and negative cannabis effects (βs=0.09-0.16, ps<0.05), and MDD symptoms were associated with fewer negative cigarette effects (β=-0.13, p=0.04) and more negative cannabis effects (β=0.10, p=0.004). The acceleration of positive alcohol and cannabis effects over time was slower among adolescents with higher baseline MDD (MDD×time: β=-0.04, p=0.044) and GAD (GAD×time: β=-0.05, p=0.03) symptoms, respectively. These findings suggest that emotional dysfunction factors show differential and overlapping effects on subjective drug effects, which may vary across time. Future research should investigate emotional dysfunctions and subjective drug effects in relation to substance use across adolescence and emerging adulthood.
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25
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Gimeno C, Dorado ML, Roncero C, Szerman N, Vega P, Balanzá-Martínez V, Alvarez FJ. Treatment of Comorbid Alcohol Dependence and Anxiety Disorder: Review of the Scientific Evidence and Recommendations for Treatment. Front Psychiatry 2017; 8:173. [PMID: 29018367 PMCID: PMC5614930 DOI: 10.3389/fpsyt.2017.00173] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/04/2017] [Indexed: 01/11/2023] Open
Abstract
Patients with alcohol-use disorders (AUDs) have a high prevalence of anxiety disorders (AnxDs). "Co-occurring disorders" refers to the coexistence of an AUD and/or drug related disorders with another non-addictive psychiatric disorder. The aim of this study was to assess the effectiveness of psychopharmacological treatments and psychotherapy in patients with AUD and AnxD and to propose recommendations for the treatment of patients with comorbid AnxDs and AUDs. Randomized clinical trials, meta-analyses, and clinical guidelines were retrieved from PubMed, Embase, and Cochrane databases. Paroxetine was found to be effective in social anxiety patients with alcohol dependence. Selective serotonin reuptake inhibitors (SSRIs), especially sertraline, showed effective results in posttraumatic stress disorder and in comorbid AnxD-AUD. However, SSRIs should be used with caution when patients are actively drinking because they may increase alcohol consumption. Buspirone, gabapentin, and pregabalin were found to be effective in comorbid AnxD-AUD. The treatment of dual AnxDs should start as early as possible. Since AUDs and AnxDs can reinforce each other, treatments targeting both pathologies can be effective. Women suffer from higher levels of stress and AnxDs than men, and they are also more vulnerable to maintaining alcohol consumption levels. Further research is needed in this comorbid patient population, including the study of different types of patients and gender perspectives.
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Affiliation(s)
- Carmen Gimeno
- Unit for Addictive Behaviours, Conselleria de Sanitat, Alicante, Spain
- Sociedad Española de Patología Dual, Madrid, Spain
| | - Marisa Luisa Dorado
- Sociedad Española de Patología Dual, Madrid, Spain
- Unit for Addictive Behaviors of Guillen de Castro, Conselleria de Sanitat, Valencia, Spain
| | - Carlos Roncero
- Sociedad Española de Patología Dual, Madrid, Spain
- Addiction and Dual Diagnosis Unit, Psychiatric Service, Hospital Vall Hebron-ASPB, CIBERSAM, Psychiatric Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nestor Szerman
- Sociedad Española de Patología Dual, Madrid, Spain
- Salud Mental Retiro, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Pablo Vega
- Sociedad Española de Patología Dual, Madrid, Spain
- Instituto de Adicciones, Madrid, Spain
| | - Vicent Balanzá-Martínez
- Service of Psychiatry, La Fe University and Polytechnic Hospital, Department of Medicine, Medical School, University of Valencia, CIBERSAM, International Society for Nutritional Psychiatry Research (ISNPR), Valencia, Spain
| | - F. Javier Alvarez
- Sociedad Española de Patología Dual, Madrid, Spain
- Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- CEIC/CEIm, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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26
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Chasson GS, Bello MS, Luxon AM, Graham TAA, Leventhal AM. Transdiagnostic emotional vulnerabilities linking obsessive-compulsive and depressive symptoms in a community-based sample of adolescents. Depress Anxiety 2017; 34:761-769. [PMID: 28661022 PMCID: PMC5546248 DOI: 10.1002/da.22669] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/15/2017] [Accepted: 06/12/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Transdiagnostic emotional vulnerabilities are suspected to underlie psychopathologic comorbidity but have received little attention in adolescent emotional pathology literature. We examined distress tolerance, anxiety sensitivity, and anhedonia as concomitant transdiagnostic mechanisms that account for (i.e., statistically mediate) the covariance between adolescent obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) symptoms. METHOD Data on MDD, OCD, and the three aforementioned transdiagnostic vulnerabilities were collected from a community-based sample of 3,094 ninth graders in a large metropolitan area and analyzed using mixed effects modeling to evaluate mediation effects. RESULTS Individually and when controlling for each other, all three transdiagnostic vulnerabilities mediated the relation between OCD and MDD symptoms both before and after adjusting for demographics. CONCLUSIONS Distress tolerance, anxiety sensitivity, and anhedonia may be unique mechanisms accounting for comorbidity between OCD and MDD symptoms in youth. Longitudinal evaluation of these candidate transdiagnostic emotional vulnerabilities in adolescent OCD-MDD comorbidity is warranted.
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Affiliation(s)
- Gregory S. Chasson
- Illinois Institute of Technology, Department of Psychology, Chicago, IL, USA,Corresponding Author: Greg Chasson, Ph.D. Illinois Institute of Technology, Department of Psychology, 3105 S. Dearborn, Pritzker Science Center, Chicago, IL 60616, , Phone: 312.567.5936, Fax: 312.567.3493
| | - Mariel S. Bello
- University of Southern California, Department of Psychology, Los Angeles, CA, USA
| | | | - Trevor A. A. Graham
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA
| | - Adam M. Leventhal
- University of Southern California, Department of Psychology, Los Angeles, CA, USA,University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA
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27
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Worden BL, Genova M, Tolin DF. Randomized Pilot of an Anxiety Sensitivity-Based Intervention for Individuals in a Substance Use Day Program. J Psychoactive Drugs 2017; 49:333-343. [PMID: 28594602 DOI: 10.1080/02791072.2017.1329570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anxiety sensitivity (AS), or the tendency to appraise physical symptoms as intolerable or dangerous, may maintain the cycle between co-occurring anxiety and substance use disorders. This study examined preliminary efficacy of a brief intervention targeting AS for individuals with heterogeneous substance use disorders. Forty-one patients with high AS entering an addictions day program were randomized to treatment as usual (TAU) or to TAU plus a nine-hour AS-focused intervention that consisted of interoceptive exposures, psychoeducation about the cycle of problematic substance use and anxiety, and a single session of cognitive challenging (e.g., reviewing common cognitive distortions and decatastrophizing anxiety symptoms). Mixed-effects intent-to-treat models suggested that participants in the AS condition showed greater decreases in AS at post-treatment, but this effect was lost at follow-up three months later. Intervention conditions did not differ in change in percent days abstinent or self-reported anxiety, with both conditions showing significant improvement at post-treatment. Results suggest that the nine-hour AS-focused intervention led to a short-term benefit over TAU alone, but this benefit was not sustained at three months' follow-up. Future AS interventions may need to target specific subconstructs of AS for selected populations, or target emotional distress tolerance more broadly.
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Affiliation(s)
- Blaise L Worden
- a Clinical Psychologist, Hartford Hospital/Institute of Living, Anxiety Disorders Center/Center for Cognitive-Behavioral Therapy , Hartford , CT , USA
| | - Marla Genova
- b Research Assistant, Institute of Living, Anxiety Disorders Center/Center for Cognitive-Behavioral Therapy , Hartford , CT , USA
| | - David F Tolin
- c Clinical Psychologist, Center Director, Institute of Living, Anxiety Disorders Center/Center for Cognitive-Behavioral Therapy, Hartford, CT, USA; Adjunct Professor, Department of Psychiatry, Yale University School of Medicine , New Haven , CT , USA
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Paulus DJ, Manning K, Hogan JBD, Zvolensky MJ. The role of anxiety sensitivity in the relation between anxious arousal and cannabis and alcohol use problems among low-income inner city racial/ethnic minorities. J Anxiety Disord 2017; 48:87-94. [PMID: 27497677 DOI: 10.1016/j.janxdis.2016.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 01/02/2023]
Abstract
The current study explored anxiety sensitivity as a factor accounting for the association between anxious arousal and problems related to use of cannabis and alcohol among a health disparity sample (low income minorities). Specifically, participants were 130 low-income racial/ethnic minorities who reported daily cannabis use (Mage=37.7 SD=10.0; 28.5% female). There were significant indirect associations of anxious arousal via anxiety sensitivity in relation to: cannabis use problems, cannabis withdrawal symptoms, use of cannabis to cope, as well as hazardous drinking, alcohol use problems, and alcohol consumption. These data indicate anxiety sensitivity is a possible mechanism underlying the relation between anxious arousal and substance use problems among low-income racial/ethnic minorities. Future work could evaluate the efficacy of cannabis and alcohol use treatments incorporating anxiety sensitivity reduction techniques to facilitate amelioration of anxiety and substance use and offset mental health inequalities for this population.
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Affiliation(s)
- Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, United States.
| | - Kara Manning
- University of Houston, Department of Psychology, Houston, TX, United States
| | | | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States
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29
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Meidlinger PC, Hope DA. The new transdiagnostic cognitive behavioral treatments: Commentary for clinicians and clinical researchers. J Anxiety Disord 2017; 46:101-109. [PMID: 27856069 DOI: 10.1016/j.janxdis.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/15/2022]
Abstract
Recognition of the limitations of the current categorical diagnostic system and increased understanding of commonalities across clinical problems associated with negative emotion, including anxiety and depression, has led to the development of transdiagnostic psychological interventions. This new approach holds promise in shifting our emphasis from diagnostic categories to treating core construct that cut across disorders. This paper identifies some of the similarities and differences across various cognitive-behavioral transdiagnostic protocols and key challenges in assessment and case conceptualization for clinicians wishing to use this approach. Some key needs in the research literature that would be particularly helpful to clinicians are also identified.
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Vujanovic AA, Meyer TD, Heads AM, Stotts AL, Villarreal YR, Schmitz JM. Cognitive-behavioral therapies for depression and substance use disorders: An overview of traditional, third-wave, and transdiagnostic approaches. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:402-415. [PMID: 27494547 DOI: 10.1080/00952990.2016.1199697] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously. OBJECTIVES The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity. RESULTS Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression. CONCLUSION Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.
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Affiliation(s)
- Anka A Vujanovic
- a Department of Psychology, University of Houston , Houston , TX , USA.,b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Thomas D Meyer
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Angela M Heads
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Angela L Stotts
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Yolanda R Villarreal
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Joy M Schmitz
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
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31
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Van Eck K, Warren P, Flory K. A Variable-Centered and Person-Centered Evaluation of Emotion Regulation and Distress Tolerance: Links to Emotional and Behavioral Concerns. J Youth Adolesc 2016; 46:136-150. [DOI: 10.1007/s10964-016-0542-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
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Wolitzky-Taylor K, McBeth J, Guillot CR, Stone MD, Kirkpatrick MG, Zvolensky MJ, Buckner JD, Leventhal AM. Transdiagnostic processes linking anxiety symptoms and substance use problems among adolescents. J Addict Dis 2016; 35:266-277. [PMID: 27431313 DOI: 10.1080/10550887.2016.1207969] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Numerous anxiety syndromes co-occur with substance use problems in adolescents, though the mechanisms underlying these comorbidities are not well understood. There are 3 transdiagnostic processes-anxiety sensitivity (fear of anxiety-related sensations), distress tolerance (capacity to withstand emotional distress), and negative urgency (propensity to respond impulsively to negative emotion)-that have been implicated in various anxiety and substance use problems. To examine whether anxiety sensitivity, distress tolerance, and negative urgency statistically mediated relations between symptoms of 3 different anxiety disorders (social anxiety, generalized anxiety, and panic disorders) and alcohol and cannabis use problems, cross-sectional analysis of high school students in Los Angeles (N = 3002) was assessed via paper and pencil questionnaires. When mediators were entered simultaneously, negative urgency accounted for a significant 33 to 85% of the covariance between anxiety symptomatology and substance use problems over and above the other trandiagnostic processes. This pattern was consistent across all 3 anxiety syndromes and both alcohol and cannabis problems. Anxiety sensitivity and distress tolerance did not account for positive associations between anxiety symptoms and substance use problems. Negative urgency may be an important mechanism underlying the relationship between various types of anxiety and substance use problems in adolescence, and thus represents a possible target for preventive interventions targeting adolescent anxiety and substance use.
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Affiliation(s)
| | - Julia McBeth
- b University of Southern California , Los Angeles , California , USA
| | - Casey R Guillot
- b University of Southern California , Los Angeles , California , USA
| | - Matthew D Stone
- b University of Southern California , Los Angeles , California , USA
| | | | | | - Julia D Buckner
- d Louisiana State University , Baton Rouge , Louisiana , USA
| | - Adam M Leventhal
- b University of Southern California , Los Angeles , California , USA
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Semcho S, Bilsky SA, Lewis SF, Leen-Feldner EW. Distress tolerance predicts coping motives for marijuana use among treatment seeking young adults. Addict Behav 2016; 58:85-9. [PMID: 26921722 DOI: 10.1016/j.addbeh.2016.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
Given increasing marijuana use and abuse among young adults in the United States and the associated physical and mental health consequences, it is important to improve our understanding of factors that may contribute to problematic marijuana use. A convergence of theory and research underscores the relevance of particular marijuana use motives generally, and coping-related motives specifically, in enhancing risk for marijuana use problems. Distress tolerance is a transdiagnostic emotion vulnerability factor that may relate to coping-related motives for marijuana use. The current study was designed to further explore this relationship within a treatment-seeking sample of young adults (Mage=24.40; SD=2.06 years). Results were consistent with hypotheses, suggesting distress tolerance is related to coping motives for marijuana use within this treatment-seeking sample, even after accounting for a number of theoretically relevant covariates. Theoretical and applied implications of distress tolerance as it relates to coping motives for marijuana use as treatment targets are discussed.
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34
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Brooks Holliday S, Pedersen ER, Leventhal AM. Depression, posttraumatic stress, and alcohol misuse in young adult veterans: The transdiagnostic role of distress tolerance. Drug Alcohol Depend 2016; 161:348-55. [PMID: 26948757 PMCID: PMC4792662 DOI: 10.1016/j.drugalcdep.2016.02.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/15/2016] [Accepted: 02/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alcohol misuse is common among young adult veterans, and is commonly associated with depression and posttraumatic stress disorder (PTSD). In fact, rates of comorbid depression, PTSD, and problem drinking are high in this population. Although distress tolerance, the capacity to experience and withstand negative psychological states, has been examined as a potential transdiagnostic factor that accounts for the development of mental health disorders, problem drinking, and the comorbidity between these presenting concerns, its role has not been evaluated in a veteran population. METHODS Young adult veterans were recruited for an online survey related to alcohol use. Participants (n=783) completed self-report measures of alcohol use, depression and PTSD symptoms, and distress tolerance. Mediation models were conducted to examine whether distress tolerance mediated the relationship between (1) probable PTSD, (2) probable depression, and (3) comorbid probable PTSD and depression with alcohol misuse. Moderated mediation models were conducted to examine gender as a moderator. RESULTS Significant bivariate associations were observed among mental health symptoms, distress tolerance, and alcohol misuse. Distress tolerance significantly mediated the relationship between probable depression and PTSD (both alone and in combination) and alcohol misuse. Evidence of moderated mediation was present for probable PTSD and probable comorbid PTSD and depression, such that the indirect effect was stronger among males. CONCLUSIONS These results suggest that distress tolerance may be a transdiagnostic factor explaining the comorbidity of depression and PTSD with alcohol misuse in young adult veterans. These findings may inform screening and intervention efforts with this high-risk population.
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Affiliation(s)
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States
| | - Adam M Leventhal
- University of Southern California, Los Angeles, CA 90089, United States
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Chuang CWI, Chan C, Leventhal AM. Adolescent Emotional Pathology and Lifetime History of Alcohol or Drug Use With and Without Comorbid Tobacco Use. J Dual Diagn 2016; 12:27-35. [PMID: 26829183 PMCID: PMC4836990 DOI: 10.1080/15504263.2016.1146557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Use of drugs and alcohol, including tobacco, is linked to adolescent emotional psychopathology. Given that tobacco use is becoming less common over recent years, its co-use with drugs/alcohol may mark a more severe profile of emotional symptomatology. However, it is unclear whether teens with a lifetime history of using drug/alcohol and tobacco exhibit additional elevations in emotional psychopathology and/or multiple forms of emotional psychopathology compared to teens with lifetime drug/alcohol use without comorbid tobacco use. This cross-sectional study compared emotional disorder symptoms and emotional vulnerability traits among adolescents with varying histories of substance use. METHODS Ninth-grade students enrolled at two schools in Los Angeles, California, were recruited; 575 met eligibility criteria and provided both student assent and parental consent. Students completed self-report measures of emotional pathology, transdiagnostic, and lifetime substance use. Participants were classified into three groupings: (a) no history of substance use (n = 294); (b) lifetime history of drug/alcohol use without tobacco use (n = 166); and (c) lifetime history of drug/alcohol use with concomitant tobacco use (n = 115). RESULTS Chi-square results showed that teens with lifetime alcohol/drug use with (vs. without) comorbid tobacco use were more likely to have used 10 of 16 substances assessed in the study. Post-ANOVA pairwise tests revealed that, compared to students with no history of substance use, those with any history of use (alcohol/drugs with and without tobacco use) had higher major depression symptoms and negative affect. Those with lifetime alcohol/drug use with comorbid tobacco use had higher generalized anxiety symptoms and distress, and those with lifetime alcohol/drug use without comorbid tobacco use had higher panic disorder symptoms and anhedonia. There were no significant differences between adolescents with lifetime drug/alcohol use with comorbid tobacco use versus those without tobacco use. CONCLUSIONS Adolescents with (vs. without) a lifetime history of drug/alcohol use endorse greater emotional symptomatology and trait vulnerabilities, regardless of comorbid lifetime tobacco use. Thus, the extent to which tobacco serves as a gateway to, correlate of, or consequence of other substance use may have little bearing on adolescent emotional health. This study's findings further suggest that emotional vulnerability (in addition to manifest psychopathology) should be considered in adolescent substance use and mental illness prevention.
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Affiliation(s)
- Cheng-Wei I. Chuang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA;
| | - Connie Chan
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA;
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Psychology, University of Southern California, Los Angeles, CA, USA
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