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Anderson GN, Conway CC, Bravo AJ. Distress tolerance is linked with substance use motivations and problems in young adults across four continents. J Pers 2024. [PMID: 39012203 DOI: 10.1111/jopy.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/20/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION People low in trait distress tolerance are at higher risk for harmful patterns of substance use. Some evidence suggests that maladaptive motives for substance use account for this correlation. However, the generality of these associations remains in doubt because virtually all available data come from North American samples. METHOD Using data from 7 countries (total N = 5858; U.S., Argentina, Uruguay, Spain, South Africa, Canada, and England), we examined distress tolerance's association with alcohol- and cannabis-related problems in young adults. On an exploratory basis, we examined how distress tolerance related to different substance-use motivations. RESULTS We found that distress tolerance was inversely related to problematic alcohol and cannabis use (rs = -0.14 and - 0.13). There was notable variation across countries in the magnitude of these effects, particularly for cannabis-related problems. Additionally, exploratory analyses revealed statistically significant (cross-sectional) indirect effects of distress tolerance on substance-related problems via substance-use motivations related to neutralizing negative emotions. CONCLUSIONS Distress tolerance's role in substance-use problems appears to generalize beyond North America, although effect sizes were generally small and varied notably across geographical regions. Distress tolerance's connection with negative reinforcement processes (e.g., coping motives) warrants attention as a possible mediator of its association with problematic substance use.
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Affiliation(s)
- Grace N Anderson
- Department of Psychology, Fordham University, Bronx, New York, USA
| | | | - Adrian J Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
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2
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Bhuptani PH, Block A, Jiménez Muñoz P, Bello MS, Ramsey S, Ranney M, Carey K, Rich J, Langdon K. Enhancing distress tolerance to uplift motivation in recovery: Results from an open development trial. Digit Health 2023; 9:20552076231158575. [PMID: 36845079 PMCID: PMC9950608 DOI: 10.1177/20552076231158575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Objective This open pilot study examines the feasibility, acceptability, and qualitative outcomes of an interactive web- and text message-delivered personalized feedback intervention aimed at cultivating motivation and tolerance of distress for adults initiating outpatient buprenorphine treatment. Methods Patients (n = 10) initiating buprenorphine within the past 8 weeks first completed a web-based intervention focused on enhancing motivation and providing psychoeducation on distress tolerance skills. Participants then received 8 weeks of daily personalized text messages that provided reminders of salient motivational factors and recommended distress tolerance-oriented coping skills. Participants completed self-report measures to assess intervention satisfaction, perceived usability, and preliminary efficacy. Additional perspectives were captured via qualitative exit interviews. Results In total, 100% of retained participants (n = 9) engaged with the text messages throughout the entire 8-week period. Mean scores of 27 (SD = 5.05) on the Client Satisfaction Questionnaire at the end of 8-week period indicated a high degree of satisfaction with the text-based intervention. The average rating on the System Usability Scale was 65.3 at the end of the 8-week program, suggesting that the intervention was relatively easy to use. Participants also endorsed positive experiences with the intervention during qualitative interviews. Clinical improvements were observed across the intervention period. Conclusions Preliminary findings from this pilot suggest that the content and delivery method of this combined web- and text message-based personalized feedback intervention is perceived by patients as feasible and acceptable. Leveraging digital health platforms to augment buprenorphine has potential for high scalability and impact to reduce opioid use, increase adherence/retention to treatment, and prevent future incidence of overdose. Future work will evaluate the efficacy of the intervention in a randomized clinical trial design.
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Affiliation(s)
- Prachi H. Bhuptani
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA
| | - Amanda Block
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Brown-Lifespan Center for Digital Health, Providence, RI, USA
| | - Paola Jiménez Muñoz
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Brown-Lifespan Center for Digital Health, Providence, RI, USA
| | - Mariel S. Bello
- Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA
| | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA,Department of Medicine, Alpert Medical School of Brown University,
Providence, RI, USA,Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Megan Ranney
- Brown-Lifespan Center for Digital Health, Providence, RI, USA,School of Public Health, Brown University, Providence, RI, USA
| | - Kate Carey
- Department of Behavioral and Social Sciences, Brown University School of Public
Health, Providence, RI, USA,Center for Alcohol and Addiction Studies, Brown University School of Public
Health, Providence, RI, USA
| | - Josiah Rich
- Department of Medicine and Epidemiology, Brown University,
Providence, RI, USA,Center for Prisoner Health and Human Rights, The Miriam Hospital,
Providence, RI, USA
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA,Brown-Lifespan Center for Digital Health, Providence, RI, USA,Kirsten Langdon, Department of Psychiatry,
Rhode Island Hospital, 146 West River, Street, Suite 11A, Providence, RI 02904,
USA.
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3
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Langdon KJ, Jiménez Muñoz P, Block A, Scherzer C, Ramsey S. Feasibility and Acceptability of a Digital Health Intervention to Promote Continued Engagement in Medication for Opioid Use Disorder Following Release From Jail/Prison. Subst Abuse 2022; 16:11782218221127111. [PMID: 36188441 PMCID: PMC9520134 DOI: 10.1177/11782218221127111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Background: Despite the extensive benefits of implementing Medications for Opioid Use Disorder (MOUD) in jail/prison, criminal justice-involved populations face significant challenges when transitioning back to the community following a period of incarceration. These risk factors are associated with increased drug use and discontinuation of evidence-based care. Novel intervention strategies are needed to support this high-risk period of transition. The primary objective of this protocol was to gather perspectives from the target population to optimize feasibility and acceptability of a combined in-person and text message-delivered intervention designed to support community reentry and continuation of MOUD. Methods: Participants (n = 8), who had prior experience engaging in MOUD while in jail/prison, were recruited from an outpatient primary care clinic in Rhode Island. A semi-structured interview was conducted to assess barriers/facilitators to technology following release, experiences of community reentry and OUD treatment, perceptions of continuum of care, and feasibility/acceptability of the intervention. All interviews were coded independently by 2 research assistants. Results: Participants reacted positively toward an intervention designed to support the transition to community-based care. Most participants denied any apprehension about using this type of platform. Obtaining a cell phone following release was endorsed as generally viable; however, special consideration must be paid to the consistency of cell phone service as well as digital literacy. Participants readily agreed on the utility of structured, daily text messages that provide motivational reminders and distress tolerance skill suggestions as well as the opportunity to access “on-demand” support. Conclusion: Overall, individuals engaged in MOUD while in jail/prison were receptive to a motivational- and distress tolerance-based digital health intervention to support recovery. Incorporating thematic results on suggested structural changes may increase the usability of this intervention to promote continuation of MOUD following release from jail/prison.
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Affiliation(s)
- Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Brown-Lifespan Center for Digital Health, Providence, RI, USA
| | - Paola Jiménez Muñoz
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Brown-Lifespan Center for Digital Health, Providence, RI, USA
| | - Amanda Block
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Brown-Lifespan Center for Digital Health, Providence, RI, USA
| | - Caroline Scherzer
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Providence, RI, USA
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4
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Barbosa-Leiker C, Campbell ANC, McHugh RK, Guille C, Greenfield SF. Opioid Use Disorder in Women and the Implications for Treatment. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2021; 3:3-11. [PMID: 34870109 PMCID: PMC8639162 DOI: 10.1176/appi.prcp.20190051] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective The opioid epidemic continues to evolve and impact all groups of people. Moreover, there are concerning trends among women. The aim of this article is to provide a review of opioid use disorder in women and the implications for treatment. Methods A nonsystematic review of the literature as conducted to examine: (1) the epidemiology of opioid-related hospitalizations and deaths of women; (2) co-occurring pain, anxiety disorders, and trauma among women with opioid use disorder; (3) evidence for opioid agonist treatment of pregnant women with opioid use disorder; and (4) implications for treatment of women with opioid use disorder and next steps for research and practice. Results The current opioid epidemic has produced important differences by sex and gender with increased rates of use and overdose deaths in women. Significant mental health concerns for women include co-occurring psychiatric disorders and suicide. Expanding medication treatment for perinatal opioid use disorder is crucial. While effective treatments exist for opioid use disorder, they are often not accessible, and a minority of patients are treated. Conclusions The end to the opioid epidemic will require innovative multi-systemic solutions. There are significant practice gaps in preventing rising death rates among women by opioid overdose, treating co-occurring psychiatric disorders and pain, and treating perinatal women with opioid use disorder and their infants. Research on sex and gender differences, and the intersection with race/ethnicity and US region, is critically needed and should include treatment implementation studies to achieve wider access for women to effective prevention, early intervention, and treatment.
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Affiliation(s)
- Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, (Barbosa-Leiker); Program of Excellence in Addictions Research, Washington State University, Spokane, (Barbosa-Leiker); Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, (Campbell); Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts (McHugh, Greenfield); Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Medical University of South Carolina, Charleston, (Guille)
| | - Aimee N C Campbell
- College of Nursing, Washington State University, Spokane, (Barbosa-Leiker); Program of Excellence in Addictions Research, Washington State University, Spokane, (Barbosa-Leiker); Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, (Campbell); Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts (McHugh, Greenfield); Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Medical University of South Carolina, Charleston, (Guille)
| | - R Kathryn McHugh
- College of Nursing, Washington State University, Spokane, (Barbosa-Leiker); Program of Excellence in Addictions Research, Washington State University, Spokane, (Barbosa-Leiker); Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, (Campbell); Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts (McHugh, Greenfield); Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Medical University of South Carolina, Charleston, (Guille)
| | - Constance Guille
- College of Nursing, Washington State University, Spokane, (Barbosa-Leiker); Program of Excellence in Addictions Research, Washington State University, Spokane, (Barbosa-Leiker); Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, (Campbell); Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts (McHugh, Greenfield); Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Medical University of South Carolina, Charleston, (Guille)
| | - Shelly F Greenfield
- College of Nursing, Washington State University, Spokane, (Barbosa-Leiker); Program of Excellence in Addictions Research, Washington State University, Spokane, (Barbosa-Leiker); Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, (Campbell); Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts (McHugh, Greenfield); Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Medical University of South Carolina, Charleston, (Guille)
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Zvolensky MJ, Rogers AH, Garey L, Shepherd JM, Ditre JW. Opioid Misuse among Smokers with Chronic Pain: Relations with Substance Use and Mental Health. Behav Med 2021; 47:335-343. [PMID: 34719341 DOI: 10.1080/08964289.2020.1742642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Opioid misuse is a significant public health concern with substantial medical, social, and economic costs. Cross cutting the personal and societal effects of this current crisis, opioid misuse is associated with poorer physical and mental health outcomes that impair function across numerous life domains. Importantly, opioid misuse disproportionately affects persons with chronic pain and individuals who smoke tobacco. Despite the higher risk for smokers with chronic pain to engage in opioid misuse, little work has examined how opioid misuse may be related to mental health problems, including other substance use, among this vulnerable group. The current study examined opioid misuse as a predictor of substance use and mental health problems among 187 (Mage = 39.02, SD = 9.94, 74.9% female) daily cigarette smokers with chronic pain who currently use opioids. Results indicated that opioid misuse is associated with greater tobacco (13% of variance), alcohol (27% of variance), and cannabis (22% of variance) problems, as well as anxiety (26% of variance) and depressive symptoms (26% of variance). These results highlight the potential importance of opioid misuse in terms of concurrent substance and mental health problems among smokers with chronic pain. Future work is needed to explicate directionality and temporal ordering in the observed relations.
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Affiliation(s)
- 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
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Justin M Shepherd
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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6
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Perpetration of and Victimization in Cyberbullying and Traditional Bullying in Adolescents with Attention-Deficit/Hyperactivity Disorder: Roles of Impulsivity, Frustration Intolerance, and Hostility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136872. [PMID: 34206834 PMCID: PMC8297231 DOI: 10.3390/ijerph18136872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 01/23/2023]
Abstract
Victimization and perpetration of cyberbullying and traditional bullying are prevalent among adolescents with attention-deficit/hyperactivity disorder (ADHD). This study examined the associations of impulsivity, frustration discomfort, and hostility with victimization and with the perpetration of cyberbullying and traditional bullying in adolescents with ADHD. Self-reported involvement in cyberbullying and traditional bullying was assessed in 195 adolescents with a clinical diagnosis of ADHD. Adolescents also completed questionnaires for impulsivity, frustration discomfort, and hostility. Caregivers completed the Child Behavior Checklist for adolescents’ ADHD, internalization, oppositional defiance, and problems with conduct. The associations of impulsivity, frustration discomfort, and hostility with victimization and perpetration of cyberbullying and traditional bullying were examined using logistic regression analysis. The results demonstrated that after the effects of demographic characteristics and behavioral problems were controlled for, frustration intolerance increased the risks of being cyberbullying victims and perpetrators whereas hostility increased the risks of being the victims and perpetrators of traditional bullying. Impulsivity was not significantly associated with any type of bullying involvement. Prevention and intervention programs should alleviate frustration intolerance and hostility among adolescents with ADHD.
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7
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Lin HC, Yen JY, Lin PC, Ko CH. The frustration intolerance of internet gaming disorder and its association with severity and depression. Kaohsiung J Med Sci 2021; 37:903-909. [PMID: 34002479 DOI: 10.1002/kjm2.12394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
This study aimed to evaluate the belief of frustration intolerance of individuals with internet gaming disorder (IGD) and its association with depression among them. We recruited 69 participants with IGD and 138 controls (69 regular gamers and other non-gamers). IGD is diagnosed based on DSM-5 (DSM stands for diagnostic and statistical manual of mental disorders) criteria through psychiatric interviews. They had completed the questionnaire for the belief of frustration intolerance, depression, and severity of IGD. The participant with IGD had a higher score on the frustration discomfort scale and its subscales, discomfort intolerance, entitlement, emotional intolerance, and achievement. Further regression analysis demonstrated an independent association between entitlement and IGD in control of depression. The frustration intolerance is also associated with depression and the severity of IGD among the IGD group. The discomfort intolerance and achievement were the most associated factors of depression. Frustration intolerance is a crucial irrational belief of IGD. It contributes to the severity of IGD and depression among individuals with IGD. The frustration intolerance, particularly for discomfort intolerance, entitlement, and achievement, should be assessed and intervened while treating individuals with IGD.
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Affiliation(s)
- Huang-Chi Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ju-Yu Yen
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
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8
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Anestis JC, Harrop TM, Preston OC, Bulla BA, Rodriguez TR. Assessing Physical Pain Perception and Psychological Distress Tolerance through the MMPI-2-RF: A Comparison of Multimethod Measures. J Pers Assess 2021; 104:86-97. [PMID: 33797998 DOI: 10.1080/00223891.2021.1905653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While transdiagnostic factors are important domains in clinical assessment and treatment, there is little research to link such constructs to widely accepted and utilized broadband assessments such as the Minnesota Multiphasic Personality Inventory, 2nd edition - Restructured Form (MMPI-2-RF). A handful of studies suggest the ability of the MMPI-2-RF scales to capture variance in transdiagnostic constructs; however, this literature relies solely on self-report criterion measures, despite evidence that self-report and behaviorally-indexed correlates of psychopathology may measure varied aspects of the intended construct and can often yield differing results. The current study investigated MMPI-2-RF scales' ability to assess two widely examined transdiagnostic constructs, distress tolerance and pain perception, across both self-report and behavioral indicators. The sample included 115 undergraduate students who completed a valid MMPI-2-RF and multimethod measures of pain perception and distress tolerance. The results aligned with prior research in areas of internalizing symptoms, psychopathy, and suicide risk factors in self-report, but not behaviorally-based, assessment. Implications of this inconsistency, the association between clinical assessment and transdiagnostic constructs, and the heterogeneity of the distress tolerance and pain perception constructs are discussed.
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Affiliation(s)
- Joye C Anestis
- Department of Health Behavior, Society, & Policy, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Tiffany M Harrop
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Olivia C Preston
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Brian A Bulla
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Taylor R Rodriguez
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
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Pain Acceptance Creates an Emotional Context That Protects against the Misuse of Prescription Opioids: A Study in a Sample of Patients with Chronic Noncancer Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063054. [PMID: 33809628 PMCID: PMC8002364 DOI: 10.3390/ijerph18063054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 02/05/2023]
Abstract
There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical model in which pain acceptance would regulate pain sensations and pain-related thoughts and emotions, which would be related to opioid misuse. The sample comprised 140 chronic pain patients attending two hospitals. All patients were receiving pharmacological treatment, including opioid analgesics. Structural equation modelling analyses showed a significant association between higher pain acceptance and lower pain intensity and catastrophizing, and lower levels of anxiety and depression. Only higher anxiety and depression were significantly associated with increased opioid misuse. The results suggest that levels of anxiety, depression, and pain acceptance must be assessed before opioids are prescribed. Pain acceptance implies a relationship with internal events that protects against anxiety and depression and thus against opioid misuse. Acceptance and Commitment Therapy appears to be particularly appropriate for these patients.
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10
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Anxiety and Opioid Use Disorder: Potential Targets for Treatment and Prevention. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-020-00350-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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11
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Is level of anxiety associated with overweight and obesity risk in university students? The NUTSAU Study. NUTR HOSP 2021; 38:488-494. [PMID: 33881338 DOI: 10.20960/nh.03376] [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: 11/02/2022] Open
Abstract
Introduction Introduction: effective ways of overcoming overweight may depend, in part, on the ability to identify mood disorders (anxiety is most prevalent) and their association with overeating and weight gain. The use of anthropometric indicators for such purposes can inform individual strategies for intervention before obesity sets in. Objective: to verify the association between anxiety and anthropometric indicators in university students. Methods: a cross-sectional study was conducted in 147 undergraduates across all programmes taught by the Federal University of Rio de Janeiro (UFRJ) at Macaé. A self-assessment questionnaire was administered in order to gather socioeconomic, lifestyle, and anxiety data. Anxiety status was estimated based on the State-Trait Anxiety Inventory (STAI), and interpreted based on the median of scores (p ≥ 50). An anthropometric assessment was conducted to measure the subjects' body mass, body mass index (BMI), and waist circumference (WC). Body fat percentage (%BF) data were obtained using bioelectrical impedance analysis (BIA). The data were then analyzed using the chi-square and logistic regression tests, with a 0.05 significance level. For analysis purposes, anxiety was defined as the exposure variable in the present study, and anthropometric indicators as the outcomes. Results: the students with an anxiety state p ≥ 50 presented an odds ratio (OR) of 2.69 for being overweight (p = 0.02), as well as an OR of 2.77 for having high BF (p = 0.02) in the adjusted models. Conclusion: a higher level of anxiety is associated with anthropometric indicators among university students, specifically for overweight or obesity and high BF percentages.
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12
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McHugh RK, Nguyen MD, Fitzmaurice GM, Dillon DG. Behavioral strategies to reduce stress reactivity in opioid use disorder: Study design. Health Psychol 2020; 39:806-814. [PMID: 32833482 DOI: 10.1037/hea0000862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES More than 2 million people in the United States had an opioid use disorder in 2017. Treatment for opioid use disorder-particularly medication combined with psychosocial support-is effective for reducing opioid use and decreasing overdose risk. However, approximately 50% of people who receive treatment will relapse or drop out. Stress reactivity, defined as the subjective and physiological response to stress, is heightened in people with opioid use disorder and higher stress reactivity is associated with poorer outcomes. Preliminary studies suggest that stress reactivity may be a key mechanistic target for improving outcomes. This article describes the design of an ongoing study examining behavioral strategies for reducing stress reactivity in adults with opioid use disorder. Our objective is to test the efficacy of two behavioral strategies for reducing stress reactivity and enhancing behavioral persistence in the context of stress (distress tolerance). METHOD We will recruit 120 adults with opioid use disorder and randomly assign them to brief training in (a) cognitive reappraisal, (b) affect labeling, or (c) a psychoeducational control. Participants will receive the training intervention followed by a laboratory stressor during which they will be instructed to apply the trained skill. RESULTS Subjective and physiological responses to stress will be measured as indices of stress reactivity and the stressor task will include a behavioral persistence component as a measure of distress tolerance. CONCLUSIONS The ultimate goal of this study is to inform the development of behavioral interventions that can be used as an adjunct to medication-based treatment for opioid use disorder. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Daniel G Dillon
- Center for Depression Anxiety and Stress Research, McLean Hospital
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13
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McHugh RK, Kneeland ET, Edwards RR, Jamison R, Weiss RD. Pain catastrophizing and distress intolerance: prediction of pain and emotional stress reactivity. J Behav Med 2020; 43:623-629. [PMID: 31376099 PMCID: PMC6995408 DOI: 10.1007/s10865-019-00086-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 07/25/2019] [Indexed: 12/11/2022]
Abstract
Exposure to stress is associated with poor outcomes in people with chronic pain. Dispositional variables, such as pain catastrophizing and distress intolerance, may impact reactivity to stressors. Importantly, these variables can be modified with treatment. The aim of this study was to investigate whether pain catastrophizing and distress intolerance were associated with tolerance of a pain stressor or a psychosocial stressor, and heightened negative affect following these stressors. A sample of 50 adults with chronic pain completed self-report measures and pain and psychosocial stress inductions. Results indicated that pain catastrophizing was associated with heightened anxiety during pain induction. Distress intolerance was associated with negative affect following a psychosocial stressor, and with poorer tolerance of the psychosocial stressor. Pain catastrophizing and distress intolerance are related factors, however, they exhibit distinct associations with amplification of pain and psychosocial stress reactivity. These variables may be important treatment targets in people with chronic pain.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Proctor House 3, MS 222, 115 Mill Street, Belmont, MA, 02148, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Elizabeth T Kneeland
- Division of Alcohol and Drug Abuse, McLean Hospital, Proctor House 3, MS 222, 115 Mill Street, Belmont, MA, 02148, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Robert R Edwards
- Pain Management Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Robert Jamison
- Pain Management Center, Brigham and Women's Hospital, Boston, MA, USA
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Proctor House 3, MS 222, 115 Mill Street, Belmont, MA, 02148, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Langdon KJ, Ramsey S, Scherzer C, Carey K, Ranney ML, Rich J. Development of an integrated digital health intervention to promote engagement in and adherence to medication for opioid use disorder. Addict Sci Clin Pract 2020; 15:16. [PMID: 32349790 PMCID: PMC7191734 DOI: 10.1186/s13722-020-00189-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Buprenorphine-naloxone is an evidence-based treatment for Opioid Use Disorder. However, despite its efficacy, nearly half of participants are unsuccessful in achieving stabilization (i.e., period of time following medication induction in which medication dose is adjusted to be effective in reducing cravings/withdrawal, minimize potential side effects, and eliminate illicit substance use). This paper presents the study design and protocol for a digital health intervention designed to promote engagement in and adherence to buprenorphine treatment, offered through an outpatient addiction treatment center, through motivational enhancement and distress tolerance skills training. Personalized feedback interventions represent a promising method to effectively motivate engagement in and adherence to buprenorphine treatment. These interventions are generally brief, individually tailored, and have the potential to be delivered via mobile platforms. Distress tolerance, a transdiagnostic vulnerability factor, has been implicated in the development and maintenance of substance use. Targeting distress tolerance may improve substance use treatment outcomes by promoting the ability to persist in goal-directed activity even when experiencing physical or emotional distress. METHODS The study aims are to: (1) develop and refine an interactive computer- and text message-delivered personalized feedback intervention that incorporates distress tolerance skills training for persons who have elected to initiate outpatient buprenorphine treatment (iCOPE); (2) examine the feasibility, acceptability, and preliminary efficacy of iCOPE for increasing abstinence, adherence, and retention in treatment compared to a treatment as usual comparison condition; and, (3) examine potential mechanisms that may underlie the efficacy of iCOPE in improving outcomes, including motivation, distress tolerance, self-regulation, and negative affect. DISCUSSION Results of this study will be used to determine whether to proceed with further testing through a large-scale trial. This work has the potential to improve treatment outcomes by reducing illicit opioid use, increasing adherence/retention, and preventing future overdose and other complications of illicit opioid use. Trial Registration NCT03842384.
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Affiliation(s)
- Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, 146 West River Street, Suite 11A, Providence, RI, 02904, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA.
| | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, USA
- Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Providence, USA
| | - Caroline Scherzer
- Department of Psychiatry, Rhode Island Hospital, 146 West River Street, Suite 11A, Providence, RI, 02904, USA
- Department of Emergency Medicine, Alpert Medical School Brown University, Providence, USA
| | - Kate Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, Providence, USA
| | - Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School Brown University, Providence, USA
- Emergency Digital Health Innovation Program, Brown University, Providence, USA
| | - Josiah Rich
- Department of Medicine, Alpert Medical School of Brown University, Providence, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
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15
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Seçer İ, Ulaş S. The Mediator Role of Academic Resilience in the Relationship of Anxiety Sensitivity, Social and Adaptive Functioning, and School Refusal With School Attachment in High School Students. Front Psychol 2020; 11:557. [PMID: 32373002 PMCID: PMC7186501 DOI: 10.3389/fpsyg.2020.00557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/09/2020] [Indexed: 11/13/2022] Open
Abstract
School has an important function in providing the environment for young people to acquire many skills and knowledge required by contemporary life, but the problems of attachment to school and problematic attendance all over the world reveal an increasing statistic. It is thought that some negative processes such as anxiety sensitivity, social and adaptive functioning, and school refusal can affect this problem. On the other hand, it is considered that the academic resilience of young people has an important protective function in terms of these risk factors. For this purpose, the mediator role of academic resilience between anxiety sensitivity, social and adaptive functioning, and school refusal and school attachment were examined in a Turkish sample of 452 high school students. In the process of data collection, the school refusal assessment scale, social and adaptive functioning scale, and academic resilience scale were adapted and used in the Turkish culture. In the data analysis, the structural equation model was used to determine the direct and indirect predictive effects between the variables. The results of the study showed that academic resilience fully mediated the relationship between anxiety sensitivity and school attachment, whereas it partially mediated the relationship between social and adaptive functioning and school refusal and school attachment. Based on the results of the study, it was evaluated that high academic resilience has a strong protective function against the problems of negative school attachment and problematic school absenteeism among young people, and this finding was discussed within the context of literature.
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Affiliation(s)
- İsmail Seçer
- Counseling and Guidance, Faculty of Education, Ataturk University, Erzurum, Turkey
| | - Sümeyye Ulaş
- Counseling and Guidance, School of Health, Gümüşhane University, Gümüşhane, Turkey
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Carlyle M, Rowley M, Stevens T, Karl A, Morgan CJA. Impaired empathy and increased anger following social exclusion in non-intoxicated opioid users. Psychopharmacology (Berl) 2020; 237:419-430. [PMID: 31686176 PMCID: PMC7018792 DOI: 10.1007/s00213-019-05378-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
RATIONALE Social functioning is modulated by the endogenous opioid system. In opioid use disorder, social functioning appears disrupted, but little research has delineated the nature of these deficits and their relationship to acute opioid use. OBJECTIVES The current study aimed to assess both emotional and cognitive empathy, along with subjective and physiological responses to social exclusion in opioid users who were either acutely intoxicated or non-intoxicated from using opioids. METHODS Individuals on an opioid substitution medication (OSM) were divided into 'intoxicated users' (had taken their OSM the same day as testing, n = 20) and 'non-intoxicated users' (had taken their OSM > 12 h ago, n = 20) and compared with opioid-naïve controls (n = 24). Empathy was assessed using the multifaceted empathy test and self-report questionnaire. Participants also underwent a period of social exclusion (Cyberball Game) and completed measures of mood and physiological responses (salivary cortisol and heart rate). RESULTS Non-intoxicated users had significantly lower emotional empathy (the ability to experience others' emotions), as well as greater anger after social exclusion when compared with the intoxicated users and controls. Anger did not change with social exclusion in the intoxicated user group and cortisol levels were lower overall. CONCLUSIONS Reduced ability to spontaneously share the emotions of others was reported in non-intoxicated users, particularly regarding positive emotions. There was some support for the idea of hyperalgesia to social pain, but this was restricted to an enhanced anger response in non-intoxicated users. Equivalent rates of empathy between the intoxicated users and controls could indicate some remediating effects of acute opioids.
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Affiliation(s)
- Molly Carlyle
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK.
| | - Megan Rowley
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Tobias Stevens
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Anke Karl
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Celia J A Morgan
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
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Langdon KJ, Dove K, Ramsey S. Comorbidity of opioid-related and anxiety-related symptoms and disorders. Curr Opin Psychol 2019; 30:17-23. [PMID: 30711906 PMCID: PMC6609499 DOI: 10.1016/j.copsyc.2018.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 12/28/2022]
Abstract
Opioid use disorder and anxiety disorders co-occur at strikingly high rates, and this comorbidity is marked by a more severe clinical presentation and poorer prognosis for treatment. Given the substantial morbidity and mortality associated with these two disorders, it is imperative to understand factors related to the high rates of co-occurrence in order to inform the development of specialized treatments for this population. Several lines of study suggest that simultaneously addressing opioid-related and anxiety-related symptoms and processes, particularly intolerance of distress and pain-related anxiety, may yield improved outcomes for this high risk, vulnerable population. Future work is needed to identify other novel mechanisms as well as develop specialized treatments to augment standard medication-assisted treatment.
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Affiliation(s)
- Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | | | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States; Division of General Internal Medicine, Rhode Island Hospital, United States; Department of Medicine, Alpert Medical School of Brown University, United States
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18
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Gold AK, Stathopoulou G, Otto MW. Emotion regulation and motives for illicit drug use in opioid-dependent patients. Cogn Behav Ther 2019; 49:74-80. [PMID: 30760111 DOI: 10.1080/16506073.2019.1579256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Refining the mechanisms behind illicit drug use is an important factor for improving the quality of clinical care. Research in alcohol, marijuana, and nicotine use disorders have linked coping motives (e.g. using substances to ameliorate negative emotional states) to problematic substance use. We evaluated the link between emotion regulation difficulties (as assessed via the difficulties in emotion regulation scale [DERS]) and motives for drug use (as assessed via the Drug Use Motives Questionnaire) among individuals (n = 68) with opioid use disorders who were in methadone maintenance treatment. We found that the DERS total score was significantly associated with coping motives for use. Nonacceptance of emotional responses was the only DERS domain that offered nonredundant prediction of coping motives. These findings highlight the relevance of specific emotion regulation deficits in motives for illicit drug use among individuals with opioid use disorders and may help inform targeted cognitive-behavioral treatments in this population.
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Affiliation(s)
- Alexandra K Gold
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Georgia Stathopoulou
- Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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McHugh RK, Kneeland ET. Affective vulnerability in substance use disorders. Curr Opin Psychol 2019; 30:54-58. [PMID: 30851660 DOI: 10.1016/j.copsyc.2019.01.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/07/2019] [Accepted: 01/18/2019] [Indexed: 01/04/2023]
Abstract
Substances of abuse are characterized by their rewarding effects and engagement of reward pathways in the brain. However, these substances also provide rapid relief of negative affect, and thus are highly negatively reinforcing. Accordingly, negative affectivity and other affective vulnerabilities (factors related to the experience of affect) are strongly linked to problematic substance use and substance use disorders. In this review, we provide a critical overview of the literature on affective vulnerabilities in substance use disorders. We discuss how both the experience of affect (e.g. negative affectivity, stress reactivity) and the interpretation of affect (e.g. distress intolerance, anxiety sensitivity) are pertinent to the development, maintenance, and treatment of substance use disorders.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Elizabeth T Kneeland
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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20
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Nonmedical prescription sedative/tranquilizer use in alcohol and opioid use disorders. Addict Behav 2019; 88:48-55. [PMID: 30142484 DOI: 10.1016/j.addbeh.2018.08.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/13/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022]
Abstract
AIMS Nonmedical prescription sedative/tranquilizer (e.g., benzodiazepines) use (NMSTU) increases risk of overdose when combined with opioids and/or alcohol. Yet, little is known about NMSTU among those with alcohol and opioid use disorders. We aimed to characterize NMSTU and sedative/tranquilizer use disorder among adults with alcohol use disorder (AUD) and/or opioid use disorder (OUD) in a general population sample. METHODS We conducted analyses of 2008-2014 National Survey on Drug Use and Health data; adults with past-year AUD-only (n = 27,416), OUD-only (n = 2142), and co-occurring AUD and OUD (n = 1483) were included (total N = 31,041). Multivariable logistic regression models were utilized to examine correlates of past-month NMSTU and past-year sedative/tranquilizer use disorder. Focal independent variables were polysubstance use (i.e., number of substances used in the previous year) and psychiatric distress. RESULTS Among those with AUD-only, 27.1% reported lifetime NMSTU, 7.6% reported past-year NMSTU, 2.7% reported past-month NMSTU, and 0.6% met criteria for past-year sedative/tranquilizer use disorder. Corresponding prevalence rates among those with OUD-only were 69.5%, 43.0%, 22.6%, and 11.3%. Those with co-occurring AUD and OUD displayed the highest rates of NMSTU (e.g., 27.5% with past-month NMSTU) and sedative/tranquilizer use disorder (20.2%). Across groups, more severe polysubstance use and psychiatric distress were associated with increased risk of NMSTU and sedative/tranquilizer use disorder. CONCLUSIONS Results of this analysis indicate that >25% of adults with AUD and approximately 70% of those with OUD report lifetime NMSTU. Among these populations, individuals with more polysubstance use and greater psychiatric distress might benefit from targeted interventions to reduce NMSTU.
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21
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Stathopoulou G, Pollack MH, Otto MW. Anxiety sensitivity moderates drug cravings in response to induced negative affect in opioid dependent outpatients. Addict Behav 2018; 84:75-78. [PMID: 29631093 DOI: 10.1016/j.addbeh.2018.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Georgia Stathopoulou
- Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Mark H Pollack
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
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22
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Free will in addictive behaviors: A matter of definition. Addict Behav Rep 2018; 5:94-103. [PMID: 29450231 PMCID: PMC5800588 DOI: 10.1016/j.abrep.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/11/2017] [Indexed: 01/23/2023] Open
Abstract
Certain people are at risk for using alcohol or other drugs excessively and for developing problems with their use. Their susceptibility might arise from a variety of factors, including their genetic make-up, brain chemistry, family background, personality and other psychological variables, and environmental and sociocultural variables. Moreover, after substance use has become established, there are additional cognitive-motivational variables (e.g., substance-related attentional bias) that contribute to enacting behaviors consistent with the person's motivation to acquire and use the substance. People who are at such risk are likely to choose to use addictive substances even though doing so entails negative consequences. In the sense of complete freedom from being determined by causal factors, we believe that there is no such thing as free will, but defined as ability to make choices from among multiple options, even though the choices are ultimately governed by natural processes, addicted individuals are free to choose. Although they might appear unable to exercise this kind of free will in decisions about their substance use, addictive behaviors are ultimately always goal-directed and voluntary. Such goal pursuits manifest considerable flexibility. Even some severely addicted individuals can cease their use when the value of continuing the use abruptly declines or when the subjective cost of continuing the use is too great with respect to the incentives in other areas of their lives. Formal treatment strategies (e.g., contingency management, Systematic Motivational Counseling, cognitive training) can also be used to facilitate this reversal.
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23
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Garner LE, Van Kirk N, Tifft ED, Krompinger JW, Mathes BM, Fraire M, Falkenstein MJ, Brennan BP, Crosby JM, Elias JA. Validation of the distress tolerance scale-short form in obsessive compulsive disorder. J Clin Psychol 2017; 74:916-925. [PMID: 29139125 DOI: 10.1002/jclp.22554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/08/2017] [Accepted: 08/01/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to develop and validate the Distress Tolerance Scale-Short Form (DTS-SF), a modification of the original Distress Tolerance Scale, in a severe/complex sample of individuals with obsessive compulsive disorder (OCD). Currently, there are multiple self-report measurements of distress tolerance (DT), highlighting the need for a more refined measure. METHOD Participants included 222 individuals with a primary diagnosis of OCD (57% male, average age = 31) seeking intensive/residential treatment. Participants completed surveys at admission, discharge, and each week. RESULTS An exploratory factor analysis revealed a one-factor solution representing overall DT ability. The DTS-SF was found to be sensitive to treatment effects. Appropriate associations between the DTS-SF and other measures were also found, with lower DT associated with greater OCD and depression severity and lower reported quality of life. CONCLUSION The DTS-SF was found to be a valid and reliable measure with high clinical utility for quickly and accurately measuring DT.
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Affiliation(s)
| | - Nathaniel Van Kirk
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Eric D Tifft
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478
| | - Jason W Krompinger
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Brittany M Mathes
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Maria Fraire
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Martha J Falkenstein
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Brian P Brennan
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Jesse M Crosby
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
| | - Jason A Elias
- McLean Hospital, 115 Mill St., Belmont, MA, USA, 02478.,Harvard Medical School, Boston, MA, USA
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McHugh RK, Votaw VR, Barlow DH, Fitzmaurice GM, Greenfield SF, Weiss RD. Development of an integrated cognitive behavioral therapy for anxiety and opioid use disorder: Study protocol and methods. Contemp Clin Trials 2017; 60:105-112. [PMID: 28689852 PMCID: PMC5553551 DOI: 10.1016/j.cct.2017.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 01/17/2023]
Abstract
Opioid use disorder is a highly disabling psychiatric disorder, and is associated with both significant functional disruption and risk for negative health outcomes such as infectious disease and fatal overdose. Even among those who receive evidence-based pharmacotherapy for opioid use disorder, many drop out of treatment or relapse, highlighting the importance of novel treatment strategies for this population. Over 60% of those with opioid use disorder also meet diagnostic criteria for an anxiety disorder; however, efficacious treatments for this common co-occurrence have not be established. This manuscript describes the rationale and methods for a behavioral treatment development study designed to develop and test an integrated cognitive-behavioral therapy for those with co-occurring opioid use disorder and anxiety disorders. The aims of the study are (1) to develop and pilot test a new manualized cognitive behavioral therapy for co-occurring opioid use disorder and anxiety disorders, (2) to test the efficacy of this treatment relative to an active comparison treatment that targets opioid use disorder alone, and (3) to investigate the role of stress reactivity in both prognosis and recovery from opioid use disorder and anxiety disorders. Our overarching aim is to investigate whether this new treatment improves both anxiety and opioid use disorder outcomes relative to standard treatment. Identifying optimal treatment strategies for this population are needed to improve outcomes among those with this highly disabling and life-threatening disorder.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Victoria R Votaw
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - David H Barlow
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02116, USA
| | - Garrett M Fitzmaurice
- Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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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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McHugh RK, Weiss RD, Cornelius M, Martel MO, Jamison RN, Edwards RR. Distress Intolerance and Prescription Opioid Misuse Among Patients With Chronic Pain. THE JOURNAL OF PAIN 2016; 17:806-14. [PMID: 27058161 DOI: 10.1016/j.jpain.2016.03.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/23/2016] [Accepted: 03/18/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED The risk for misuse of opioid medications is a significant challenge in the management of chronic pain. The identification of those who may be at greater risk for misusing opioids is needed to facilitate closer monitoring of high-risk subgroups, and may help to identify therapeutic targets for mitigating this risk. The aim of this study was to examine whether distress intolerance-the perceived or actual inability to manage negative emotional and somatic states-was associated with opioid misuse in those with chronic pain. A sample of 51 participants prescribed opioid analgesics for chronic back or neck pain were recruited for a 1-time laboratory study. Participants completed measures of distress intolerance and opioid misuse, and a quantitative sensory testing battery. Results suggested that distress intolerance was associated with opioid misuse, even controlling for pain severity and negative affect. Distress intolerance was not associated with pain severity, threshold, or tolerance, but was associated with self-reported anxiety and stress after noxious stimuli. This study found robust differences in distress intolerance between adults with chronic pain with and without opioid medication misuse. Distress intolerance may be a relevant marker of risk for opioid misuse among those with chronic pain. PERSPECTIVE This study demonstrated that distress intolerance was associated with opioid misuse in adults with chronic pain who were prescribed opioids. Distress intolerance can be modified with treatment, and thus may be relevant not only for identification of risk for opioid misuse, but also for mitigation of this risk.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Marise Cornelius
- Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts
| | - Marc O Martel
- Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
| | - Robert N Jamison
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
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Szuhany KL, Otto MW. Contextual Influences on Distress Intolerance: Priming Effects on Behavioral Persistence. COGNITIVE THERAPY AND RESEARCH 2015; 39:499-507. [PMID: 26366022 PMCID: PMC4564134 DOI: 10.1007/s10608-015-9672-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Distress intolerance (DI), the inability to tolerate stressful experiences, has been linked to multiple psychiatric conditions and maladaptive coping patterns. Although DI is often considered a trait-like variable, evidence indicates that self-report and behavioral indices of DI can be manipulated by contextual factors. Understanding such contextual influences is important given evidence of unexpected variability in these presumed trait-like measures over brief intervals. The current study examined the influence of context (manipulated by priming concepts of "Interminability" and "Brevity") in predicting behavioral persistence, in relation to self-reported DI. Results indicated that priming Brevity was associated with terminating a cold-pressor task more quickly. Self-reported DI was linked to earlier termination, but there was no interaction between self-reported DI and priming condition. Results indicate that contextual cues modulate performance on behavioral measures of DI. Hence, models of DI should consider both trait-like and contextual factors in understanding variability in DI measures.
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Affiliation(s)
- Kristin L Szuhany
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon St., 5 Floor, Boston, MA, 02215, United States
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon St., 5 Floor, Boston, MA, 02215, United States
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Kiselica AM, Rojas E, Bornovalova MA, Dube C. The Nomological Network of Self-Reported Distress Tolerance. Assessment 2014; 22:715-29. [DOI: 10.1177/1073191114559407] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Distress tolerance (DT), or the ability to withstand psychological distress, is a popular construct in the psychological literature. However, research has not specified the nomological network of DT across self-report measures. The purpose of the current investigation was to understand what personality features, environmental stressors, current affective states, and behaviors contribute to DT in two different samples: college students and those in residential substance use treatment. Correlations revealed that self-reported DT was most strongly associated with trait negative emotionality, state negative affect, impulsivity, and perceived stress. In comparisons across samples, self-harm exhibited a stronger relationship with self-reported DT in the drug treatment than in the student sample, whereas perceived stress had a stronger association in the student sample. Correlations between self-report and behavioral measures of DT were nonsignificant. To understand this lack of associations, associations of outcomes with behavioral measures were assessed. In contrast to self-reported DT, behavioral DT was more closely related to achievement orientation, state negative affect, and state positive affect, but was not significantly related to psychopathology and maladaptive behaviors. It is necessary to continue investigating the construct validity of behavioral DT measures via the use of incremental utility analyses and experimental approaches.
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Affiliation(s)
| | | | | | - Chad Dube
- University of South Florida, Tampa, FL, USA
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Kertz SJ, Stevens KT, McHugh RK, Björgvinsson T. Distress intolerance and worry: the mediating role of cognitive variables. ANXIETY STRESS AND COPING 2014; 28:408-24. [PMID: 25314145 DOI: 10.1080/10615806.2014.974571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Distress intolerance (DI) has been identified as a potential risk factor for a variety of maladaptive avoidance behaviors, including worry. However, mechanisms linking DI to specific behaviors remain poorly understood. One hypothesis is that DI is a general vulnerability that confers risk of particular avoidance behaviors via more specific, lower-order vulnerabilities. The current study examined associations between DI and worry-related cognitions. DESIGN A multiple mediator model tested the hypothesis that worry-related variables (intolerance of uncertainty [IU], cognitive avoidance, beliefs about worry, and negative problem orientation) mediated the association between DI and worry. METHODS An undergraduate student (n = 281) and a clinical (n = 123) sample completed self-report measures. RESULTS Across samples, worry was associated with higher levels of DI, IU, cognitive avoidance, beliefs about worry, and negative problem orientation. Mediation results differed somewhat between the two samples. In the undergraduate sample, IU, negative beliefs about worry, and positive beliefs about worry mediated the association between DI and worry. In the clinical sample, negative problem orientation and negative beliefs about worry mediated the association between DI and worry. CONCLUSIONS Results provide initial evidence that DI may be associated with worry via unique risk factors.
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Affiliation(s)
- Sarah J Kertz
- a Psychology Department , Southern Illinois University , Carbondale , IL , USA
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Caselli G, Canfora F, Ruggiero GM, Sassaroli S, Albery IP, Spada MM. Desire Thinking Mediates the Relationship between Emotional Intolerance and Problem Drinking. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9520-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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McHugh RK, Kertz SJ, Weiss RB, Baskin-Sommers AR, Hearon BA, Björgvinsson T. Changes in distress intolerance and treatment outcome in a partial hospital setting. Behav Ther 2014; 45:232-40. [PMID: 24491198 PMCID: PMC4191891 DOI: 10.1016/j.beth.2013.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 10/28/2013] [Accepted: 11/04/2013] [Indexed: 11/23/2022]
Abstract
Despite the well-established role of distress intolerance (DI) in a wide range of psychological disorders, few studies have examined whether DI improves during treatment and whether these changes are associated with symptom outcomes. Patients (N=626) enrolled in a brief cognitive-behavioral partial hospital program completed pre- and posttreatment measures of DI. Results indicated that DI decreased significantly during treatment, with more than 30% of the sample exhibiting a reduction of more than 2 standard deviations from the sample mean. Women reported higher DI than men at baseline; however, there were no gender differences in changes in DI over time. Participants also completed a pre- and posttreatment measure of depression and a subset completed a measure of anxiety (n=167). DI was associated with more severe depression and anxiety at pre- and posttreatment, with participants who reported a decrease in DI also reporting lower depression and anxiety symptoms at post-treatment. These results further highlight the transdiagnostic relevance of DI and suggest that DI may be a relevant factor in treatment outcome for depression and anxiety.
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Oser ML, Trafton JA, Lejuez CW, Bonn-Miller MO. Differential associations between perceived and objective measurement of distress tolerance in relation to antiretroviral treatment adherence and response among HIV-positive individuals. Behav Ther 2013; 44:432-42. [PMID: 23768670 DOI: 10.1016/j.beth.2013.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/27/2013] [Accepted: 03/27/2013] [Indexed: 11/15/2022]
Abstract
The present study sought to extend prior work, showing an association between self-reported distress tolerance and self-reported antiretroviral treatment (ART) adherence, by conducting a multimethod test of the association between distress tolerance and objective measures of ART adherence among a sample of 140 individuals (23.6% female) with human immunodeficiency virus (HIV). Findings indicated that, after accounting for negative affectivity and ART side-effect severity, distress tolerance was significantly associated with pill count adherence as well as viral load. Specifically, a differential association was observed whereby self-reported distress tolerance was associated with pill count adherence, whereas behavioral distress tolerance was associated with viral load. Importantly, no associations were observed between either measure of distress tolerance and CD4 count. Findings are discussed in terms of the importance of both behavioral and perceived distress tolerance assessment among patients with HIV as well as potential clinical implications related to the integration of distress tolerance-focused treatments into existing interventions for individuals with HIV.
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Affiliation(s)
- Megan L Oser
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02130, USA.
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