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Brinkman HR, McCarthy DE, Mendes WB, Leyro TM. An Examination of Cardiac Vagal Control Indices and Cognitive Stress Appraisal in Cigarette Smokers. Appl Psychophysiol Biofeedback 2023; 48:97-107. [PMID: 35984578 DOI: 10.1007/s10484-022-09556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
Identifying factors that influence how individuals who smoke cigarettes respond to stress is important as stress is a risk factor for smoking and its maintenance. This study examined the modulatory role of cardiac vagal control (CVC), a physiological correlate of self-regulation, on cognitive stress appraisal processes of adults who smoke. Sixty daily cigarette smokers were randomized to receive positive or negative feedback during a modified Trier Social Stress Test. Pre- and post-task stress appraisals were assessed and resting and reactivity CVC measures were computed. Moderated regression models assessed if the relation between feedback condition and post-task stress appraisal varied as a function of CVC. We hypothesized that participants receiving negative feedback would report greater post-task stress appraisal compared to participants receiving positive feedback, and the strength of the effect of both feedback groups would be greater at higher levels of CVC. All models showed significant main effects of feedback condition (b = - 0.42, p = 0.01; b = - 0.45, p = 0.01) on post-task stress appraisal: participants receiving negative feedback reported greater post-task stress appraisal. No significant main or interactive effects of CVC and feedback condition on post-task stress appraisal were observed. This study demonstrates that stress appraisals of daily cigarette smokers are sensitive to social feedback, but are not moderated by individual differences in CVC. Future investigations are needed to clarify whether this finding is explained by smoking-specific impairments in CVC as well as the distinct and interactive effects of physiological and psychological processes implicated in stress and smoking risk.
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Affiliation(s)
- Hannah R Brinkman
- Department of Psychology, Rutgers, The State University of New Jersey, 53 Avenue E, Piscataway, NJ, 08854, USA.
| | - Danielle E McCarthy
- Center for Tobacco Research and Treatment, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Wendy B Mendes
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, 53 Avenue E, Piscataway, NJ, 08854, USA
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Brinkman HR, Hoyt DL, Fedorenko EJ, Mendes WB, Leyro TM. Cardiac Vagal Control Among Community Cigarette Smokers with Low to Moderate Depressive Symptoms. Appl Psychophysiol Biofeedback 2023; 48:159-169. [PMID: 36732418 DOI: 10.1007/s10484-023-09580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
Impairments in cardiac vagal control (CVC) have been independently linked to smoking status and depression and are implicated in self-regulatory processes that may exacerbate depressive symptoms and maintain smoking behavior. Yet, few studies have examined how depressive symptoms, even at low levels, influence CVC reactivity among individuals who smoke. Investigating these relationships may provide novel insights into how depressive symptoms exacerbate existing regulatory vulnerabilities among smokers. This study investigated how depression symptoms affect CVC reactivity as a function of changing situational demands among a community sample of 60 daily adult cigarette smokers. Participants completed a mildly demanding cognitive task while physiological data was recorded. Growth curve modeling was used to examine the main and interactive effects of self-reported depressive symptoms on CVC reactivity over the course of the task. We hypothesized that greater depressive symptoms would be associated with less CVC reactivity, characterized by smaller initial reductions in CVC values and a flatter slope over time. Participants were daily smokers with mild to moderate levels of depression. Final model results, where time was specified as linear and the slope was fixed, showed no significant main or interactive effects of time and depression symptoms on CVC reactivity. Findings suggest that at low to moderate levels, depressive symptom severity is not related to patterns of CVC reactivity among adults who smoke. This is the first study to examine this relationship in this population. Future investigations that examine patterns of CVC reactivity among smokers and non-smokers with more severe depression are needed.
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Affiliation(s)
- Hannah R Brinkman
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue E, Piscataway, NJ, 08854, USA.
| | - Danielle L Hoyt
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue E, Piscataway, NJ, 08854, USA
| | - Erick J Fedorenko
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue E, Piscataway, NJ, 08854, USA
| | - Wendy Berry Mendes
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue E, Piscataway, NJ, 08854, USA
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3
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Smith JE, Brinkman HR, Aston ER, Zvolensky MJ, Leyro TM, Farris SG. Difficulties in emotion regulation and ad libitum smoking topography: A secondary analysis. Addict Behav 2023; 137:107498. [PMID: 36240535 DOI: 10.1016/j.addbeh.2022.107498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite the well-known linkages between poor emotion regulation and subjective smoking motives, little is known about the role of emotion regulation in predicting smoking reinforcement behavior. This study examined the relation between difficulties in emotion regulation and puff velocity data, a behavioral index of smoking reinforcement, in adult daily cigarette smokers. METHOD The current study was a secondary analysis of data collected from non-treatment seeking daily smokers (N = 124). Participants completed the Difficulties in Emotion Regulation Scale (DERS) followed by an ad libitum smoking period during which puff topography data was collected via a handheld puffing device. Puff velocity served as our puff topography index and was examined at the average and puff-to-puff level using regression and multi-level models, respectively. RESULTS Regression analyses showed no significant association between DERS scores and average puff velocity. In contrast, multi-level modeling found a significant quadratic time × DERS effect at the puff-to-puff level, such that those with greater emotion regulation difficulties inhaled more quickly at the initiation of the cigarette, whereas those with lower emotion regulation difficulties evidenced consistent puffing over the course of the cigarette. DISCUSSION Smokers with greater difficulties in emotion regulation appear to smoke in a way that maximizes delivery of nicotine, perhaps to self-regulate distress. One's style of puffing may reflect a possible behavioral marker of negative reinforcement smoking, especially in the context of emotional distress. IMPLICATIONS This study was the first to explore the relationship between difficulties in emotion regulation and a behavioral measure of smoking reinforcement.
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Affiliation(s)
- Jacqueline E Smith
- Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, NJ, USA
| | - Hannah R Brinkman
- Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, NJ, USA
| | - Elizabeth R Aston
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, Providence, RI, USA
| | | | - Teresa M Leyro
- Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, NJ, USA
| | - Samantha G Farris
- Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, NJ, USA.
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4
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Yang MJ, Borges AM, Emery NN, Leyro TM. Trial-level bias score versus mean bias score: Comparison of the reliability and external validity using dot-probe task among daily smokers. Addict Behav 2022; 135:107456. [PMID: 35944381 PMCID: PMC10757633 DOI: 10.1016/j.addbeh.2022.107456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Attentional bias (AB) is an individual difference risk factor that represents the extent to which cigarette cues capture one's attention. AB is typically indexed by mean bias score (MBS), theoretically assuming that AB is static. However, poor reliability of MBS has threatened valid interpretation of the results on AB. Based on observed trial-by-trial temporal fluctuation and variability of attentional allocation, trial-level bias score (TLBS) has been introduced as an alternative index with evidence of better psychometric properties in various populations, as compared to MBS. However, such evidence is limited among daily smokers. The current study aimed to replicate and extend extant findings in a sample of daily smokers by hypothesizing that TLBS, as compared to MBS, would demonstrate superior reliability and external validity. METHODS Forty-eight daily smokers completed self-reports, ad-libitum smoking, and a dot-probe task three times, which was comprised of 36 pairs of pictorial stimuli of cigarette and neutral cues, yielding 144 total trials. RESULTS The TLBS demonstrated superior internal (range intra class correlation [ICC] = 0.79-0.95) and test-retest reliability (range ICC = 0.64-0.88) compared to MBS (range ICC = 0.31-0.40 and 0.06-0.16, respectively). However, few significant relations between either the MBS or TLBS and measures of biobehavioral and self-report indices of smoking reinforcement were observed. CONCLUSIONS The current findings demonstrate that TLBS, as compared to MBS, is a more reliable measure of AB among daily smokers, while evidence of its external validity is limited.
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Affiliation(s)
- Min-Jeong Yang
- Department of Psychology, Rutgers University, Piscataway, NJ 08854, USA; Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E. Fowler Ave, Tampa, FL 33617, USA.
| | - Allison M Borges
- Department of Behavioral Health, The Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA.
| | - Noah N Emery
- Department of Psychology, Colorado State University, 210 Behavioral Sciences Building, 1876, Campus Delivery, Fort Collins, CO 80523-1876, USA.
| | - Teresa M Leyro
- Department of Psychology, Rutgers University, Piscataway, NJ 08854, USA.
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Brinkman HR, Smith JE, Leyro TM, Zvolensky MJ, Farris SG. Effect of Emotion Regulation Difficulties on Acute Smoking Urges Following a 35% Carbon Dioxide Challenge. Cogn Ther Res 2022. [DOI: 10.1007/s10608-022-10342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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6
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Yang MJ, Sawhney V, McHugh RK, Leyro TM. Examination of the indirect effect of childhood emotional trauma on internalizing symptoms through distress intolerance. J Am Coll Health 2022; 70:1347-1353. [PMID: 32877634 DOI: 10.1080/07448481.2020.1810053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Extant studies document a prospective link between early childhood trauma and internalizing symptoms, such as anxiety and depression. Less is known regarding specific cognitive-affective mechanisms. The current study sought to examine distress intolerance (DI) as a mechanism that may explain the relation between early childhood emotional abuse and internalizing symptoms. PARTICIPANTS AND METHODS Participants (N = 230; 54.3% women; mean age = 19.72, SD = 2.28) completed multiple self-report indices of early childhood emotional abuse, DI, and internalizing symptom indices. Using structural equation modeling, a series of mediation models was run to examine the indirect effect of childhood emotional abuse on latent and specific internalizing symptom indices through a latent index of subjective DI. RESULTS Childhood emotional abuse was significantly associated with internalizing symptoms through DI (effect size range = .083-.227, medium to large). CONCLUSIONS The results provide preliminary evidence for DI as a mechanism of interest in the relation between early childhood emotional abuse and internalizing symptoms.
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Affiliation(s)
- Min-Jeong Yang
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Vyom Sawhney
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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7
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Leyro TM, Versella MV, Yang MJ, Brinkman HR, Hoyt DL, Lehrer P. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clin Psychol Rev 2021; 84:101980. [PMID: 33540222 PMCID: PMC8302658 DOI: 10.1016/j.cpr.2021.101980] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Respiratory abnormalities are a hallmark of anxiety symptomatology and may serve as clinically useful modifiers for alleviating anxiety symptoms. However, gold-standard anxiety treatments (e.g., cognitive-behavioral interventions) often do not directly address respiratory components despite their theoretical utility and clinical accessibility. This review examined the clinical effectiveness of respiratory interventions, interventions that directly target respiration abnormalities and processes, in treating trait anxiety symptoms. METHODS The final analysis included 40 randomized controlled trials including at least one measure of trait anxiety, a respiratory-focused intervention group, and a non-respiratory control-group (active or inactive treatment). Overall effects of respiratory focused interventions were examined, as well as the effect of hypothesized moderators. RESULTS Respiratory component interventions yielded significantly greater improvements (moderate to large effect) in anxiety symptoms than controls, with the stronger effects observed in comparison to inactive, rather than active, control conditions. Significant heterogeneity in findings suggests that variability in intervention design, population, and control comparison may obfuscate interpretation of findings. CONCLUSIONS Evidence supports the clinical utility of respiratory interventions as either an independent anxiety treatment, or as an adjunct to other interventions. Clinical and research implications of findings along with recommendations for ongoing investigations in this domain are discussed.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, United States.
| | - Mark V Versella
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Min-Jeong Yang
- Department of Psychology, Rutgers, The State University of New Jersey, United States; Department of Health Outcomes and Behavior, Moffitt Cancer Center, United States
| | - Hannah R Brinkman
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Danielle L Hoyt
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Paul Lehrer
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, United States
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8
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Gold AK, Hoyt DL, Milligan M, Hiserodt ML, Samora J, Leyro TM, Zvolensky MJ, Otto MW. The role of fear of COVID-19 in motivation to quit smoking and reductions in cigarette smoking: a preliminary investigation of at-risk cigarette smokers. Cogn Behav Ther 2021; 50:295-304. [PMID: 33605833 DOI: 10.1080/16506073.2021.1877340] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Preliminary data suggest that cigarette smokers could have an increased mortality risk from the novel coronavirus (SARS-CoV-2), and that certain factors (e.g., increased age, medical comorbidities) can also increase risk of poor coronavirus disease (COVID-19) outcomes. Between April 30th, 2020 and May 28th, 2020, we evaluated self-reported changes in recent smoking patterns and motivation to quit smoking among current daily cigarette smokers (N = 103) on Amazon Mechanical Turk. We also assessed the relationship of these outcomes to age, medical comorbidity status, and fear of COVID-19. Most participants (68.9%) reported smoking less frequently than usual in the last 28 days. Among daily smokers, increased fear of COVID-19 predicted increased motivation to quit smoking and actual smoking reductions (ps < .05). Endorsement of one or more medical comorbidities, but not increased age, predicted increased motivation to quit smoking (p < .05). These data suggest the potentially greater relevance of psychological factors (e.g., fear of COVID-19) over external risk factors (e.g., medical comorbidity, increased age) on motivation to quit smoking and actual reductions in smoking patterns, and may reflect that the pandemic is a suitable time for offering smoking cessation intervention.
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Affiliation(s)
- Alexandra K Gold
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Danielle L Hoyt
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Megan Milligan
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michele L Hiserodt
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Jake Samora
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Steinberg ML, Rosen RL, Versella MV, Borges A, Leyro TM. A Pilot Randomized Clinical Trial of Brief Interventions to Encourage Quit Attempts in Smokers From Socioeconomic Disadvantage. Nicotine Tob Res 2020; 22:1500-1508. [PMID: 32161942 DOI: 10.1093/ntr/ntaa047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/09/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cigarette smoking disproportionately affects communities of low socioeconomic status where greater smoking prevalence and poorer cessation rates have been observed. Utilizing brief evidence-based interventions to increase cessation attempts may be an effective and easily disseminable means by which to mitigate undue burden in this population. AIMS AND METHODS The current intervention randomized daily smokers (N = 57) recruited from a local community soup kitchen to receive either Brief (eg, 30 m) Motivational Interviewing, Nicotine Replacement Therapy (NRT) sampling, or a Referral-Only intervention. Approximately half of participants (50.9%) reported not completing high school and many reported either just (41.4%) or not (40.4%) meeting basic expenses. Follow-up was completed approximately 1-month postintervention. RESULTS Nonsignificant group differences indicated that participants randomized to the NRT sampling condition were more likely to make a quit attempt (moderate effect size). Approximately 40% of the sample reported making a serious quit attempt at follow-up. Significant differences in cigarettes per day at follow-up, controlling for baseline, were observed, with participants in the Motivational Interviewing condition, only, reporting significant reductions. Participants randomized to the NRT condition were significantly more likely to report using NRT patch and lozenge at follow-up (large effect). There were no differences between groups with respect to seeking behavioral support. Finally, we found that subjective financial strain moderated the effect of condition on change in cigarette consumption where NRT sampling was more effective for participants reporting less financial strain. CONCLUSIONS Findings provide initial evidence for personalizing brief interventions to promote quit attempts in low-income smokers. IMPLICATIONS While most clinical research on tobacco use and dependence focuses on successful sustained abstinence, the current study is novel because it examined three brief interventions designed to increase the number of quit attempts made by a nontreatment-seeking group suffering from health disparities (ie, smokers from socioeconomic disadvantage). These data suggest that nontreatment-seeking smokers from socioeconomic disadvantage can be influenced by Brief MIs and these interventions should be used to motivate smokers from socioeconomic disadvantage to make a quit attempt. Future studies should examine combined MIs including pharmacological and behavioral interventions.
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Affiliation(s)
- Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, Department of Psychiatry, New Brunswick, NJ
| | - Rachel L Rosen
- Rutgers University, Department of Psychology, Piscataway, NJ
| | - Mark V Versella
- Rutgers University, Department of Psychology, Piscataway, NJ
| | - Allison Borges
- Rutgers University, Department of Psychology, Piscataway, NJ
| | - Teresa M Leyro
- Rutgers University, Department of Psychology, Piscataway, NJ
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Farris SG, Aston ER, Leyro TM, Brown LA, Zvolensky MJ. Distress Intolerance and Smoking Topography in the Context of a Biological Challenge. Nicotine Tob Res 2020; 21:568-575. [PMID: 30137455 DOI: 10.1093/ntr/nty167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/17/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Distress intolerance (DI), one's perceived or behavioral incapacity to withstand distress, is implicated in psychopathology and smoking. This study evaluated the effect of DI on smoking reinforcement in the context of a carbon dioxide (CO2) biological challenge. METHODS Adult daily smokers (n = 90; 48.9% female) were randomized to receive a single inhalation/breath of 35% CO2-enriched air (n = 45) or compressed room air (n = 45). Perceived DI was assessed before the challenge. Smoking reinforcement was examined via average post-challenge puff volume across puffs and at the puff-to-puff level. RESULTS Higher DI was associated with an increased average puff volume (b = -4.7, p = .031). CO2 produced decreased average puff volume compared with room air (b = -7.7, p = .018). There was a DI* condition interaction (ƒ2 = 0.02), such that CO2 decreased average puff volume compared with room air in smokers with higher DI (b = -13.9, t = -3.06, p = .003), but not lower DI. At the puff-to-puff level, there was a significant interaction between DI, condition, and cubic time (b = 0.0003, p =. 037). Specifically, room air produced large initial puff volumes that decreased from puff to puff over the cigarette for high- and low-DI smokers. CO2 produced persistent flat volumes from puff to puff over the cigarette for higher DI smokers, whereas CO2 produced puff volumes like that of room air in lower DI smokers. DISCUSSION Findings suggest DI heightens smoking reinforcement generally, and in the context of intense cardiorespiratory distress, is associated with stable and persistent smoking. DI is a promising therapeutic target that, if addressed through psychological intervention, may improve cessation outcomes by decreasing smoking reinforcement. IMPLICATIONS This study contributes to our understanding of the relationship between DI and smoking reinforcement, via examining these processes in response to acute cardiorespiratory distress. Specifically, we found that smokers who are less tolerant of distress, as opposed to those who are more tolerant, evince a decrease in average puff volume, and consistently low puff-to-puff volume, in response to a biological stressor. These findings suggest that smokers high in DI alter smoking behavior following acute cardiorespiratory distress, perhaps to reduce overstimulation, yet also persist in smoking in a manner that suggests an inability to achieve satiation.
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Affiliation(s)
- Samantha G Farris
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.,Centers for Behavioral and Prevention Medicine, The Miriam Hospital, Providence, RI
| | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, School of Public Health at Brown University, Providence, RI
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Lily A Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX.,Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Burr EK, O'Keeffe B, Kibbey MM, Coniglio KA, Leyro TM, Farris SG. Distress Intolerance in Relation to Reliance on Cigarettes for Weight, Shape, and Appetite Control. Int J Behav Med 2020; 27:247-254. [PMID: 32124245 DOI: 10.1007/s12529-020-09858-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Distress intolerance, one's inability to withstand distressing emotional or physical states, is a transdiagnostic vulnerability implicated in affect-based health behaviors, including cigarette smoking and poor weight control. The current study evaluated associations between distress intolerance and the reliance on cigarettes for management of weight, appetite, or body dissatisfaction, which may pose a burden for cessation and increase risk of weight-related health problems. METHOD Daily smokers (n = 577) completed an online survey assessing distress tolerance and reliance on cigarettes for weight and shape control with the four subscales of the Smoking and Weight Eating Episodes Test (SWEET). Four hierarchical regression models were constructed to test the association between distress intolerance and SWEET scores, accounting for the effect of relevant covarying factors. RESULTS After adjusting for model covariates, distress intolerance was significantly incrementally associated with greater tendency to rely on cigarettes to suppress appetite (adjR2 = .040), prevent overeating (adjR2 = .034), cope with body dissatisfaction (adjR2 = .046), and cope with nicotine withdrawal-related appetite increases (adjR2 = .030). CONCLUSION Distress intolerance may play an etiological role in maladaptive use of cigarettes to control appetite, weight, and body dissatisfaction among daily smokers, particularly those with weight- or shape-related concerns. Interventions aimed at increasing perceived ability to withstand distress could potentially reduce reliance on cigarettes for the aforementioned purposes.
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Affiliation(s)
- Emily K Burr
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue East, Piscataway, NJ, 08854, USA
| | | | - Mindy M Kibbey
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue East, Piscataway, NJ, 08854, USA
| | - Kathryn A Coniglio
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue East, Piscataway, NJ, 08854, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue East, Piscataway, NJ, 08854, USA
| | - Samantha G Farris
- Department of Psychology, Rutgers, the State University of New Jersey, 53 Avenue East, Piscataway, NJ, 08854, USA.
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12
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Borges AM, Yang MJ, Farris SG, Zvolensky M, Leyro TM. Examining the Role of Emotion Regulation in the Bidirectional Relation between Physiological and Subjective Stress Response among Daily Cigarette Smokers. Pers Individ Dif 2020; 155. [PMID: 32863505 DOI: 10.1016/j.paid.2019.109740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cigarette smoking is associated with autonomic dysregulation and altered stress responsivity. There exists a reciprocal relation between subjective and physiological stress reactivity and recovery in smokers. Emotion regulation may impact the extent to which these domains influence each other. The current study examined the moderating role of lack of emotional awareness, lack of emotional clarity, and nonacceptance of emotions, in the relation between heart rate reactivity to, and subjective recovery from, stress, and vice versa. To determine specificity of cross-domain findings, these relations were also examined within domain. Fifty-six daily smokers (46.4% female; M age = 29.33, SD = 11.92) participated in a biological challenge. Heart rate and subjective distress were assessed continuously before, during, and after the challenge. Individual growth curve models revealed that deficits in emotional clarity significantly moderated the effect of heart rate reactivity on subjective recovery. Lack of emotional awareness also moderated the association between subjective reactivity and heart rate recovery. Emotion regulation processes did not affect relations within the same domain, but altered the relation across domains.
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Affiliation(s)
| | - Min-Jeong Yang
- Department of Psychology, Rutgers University-New Brunswick
| | | | - Michael Zvolensky
- Department of Psychology, University of Houston; University of Texas MD Anderson Cancer Center; Anxiety and Health Research Laboratory and Substance Use Treatment Clinic
| | - Teresa M Leyro
- Department of Psychology, Rutgers University-New Brunswick
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13
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Rosen RL, Borges AM, Kibbey MM, Steinberg ML, Leyro TM, Farris SG. Distress intolerance and withdrawal severity among daily smokers: The role of smoking abstinence expectancies. Addict Behav 2019; 99:106048. [PMID: 31421585 DOI: 10.1016/j.addbeh.2019.106048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/10/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Distress intolerance (DI), the perceived inability to withstand distress, is implicated in cigarette smoking maintenance. Greater DI may contribute to anticipation of negative outcomes from smoking abstinence, which in turn could contribute to withdrawal symptom severity. The current study aimed to evaluate (1) the association between DI and acute abstinence expectancies and (2) the potential mediating role of abstinence expectancies in the relationship between DI and withdrawal symptom severity. METHOD Participants (n = 444) were daily smokers who reported at least one prior quit attempt, participating in a larger online study on distress and smoking. DI, subjective nicotine withdrawal, and smoking abstinence expectancies were assessed using the Distress Tolerance Scale (DTS), Minnesota Nicotine Withdrawal Scale (MNWS), and Smoking Abstinence Expectancies Questionnaire (SAEQ). RESULTS DTS was significantly negatively associated with SAEQ, specifically Negative Mood (r = -0.37, p < .001), Somatic Symptoms (r = -0.47, p < .001), and Harmful Consequences (r = -0.59, p < .001) subscales, but was not associated with Positive Expectancies subscale (r = 0.05, p = .31). Results indicated a significant effect of DTS on withdrawal symptom severity via SAEQ. Follow-up analyses indicated that the indirect effects were driven specifically by SAEQ Negative Mood and Harmful Consequences subscales. DISCUSSION DI is related to more negative abstinence expectancies, particularly affective aspects of abstinence, which may contribute to the severity of nicotine withdrawal symptoms. This study provides initial evidence of a specific cognitive process that may explain why DI contributes to heightened subjective experience of nicotine withdrawal symptoms.
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Affiliation(s)
- Rachel L Rosen
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Allison M Borges
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Mindy M Kibbey
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, Department of Psychiatry, 317 George St, New Brunswick, NJ 08901, USA
| | - Teresa M Leyro
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Samantha G Farris
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA.
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14
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Versella MV, Leyro TM. Electronic cigarettes and nicotine harm-reduction. Curr Opin Psychol 2019; 30:29-34. [DOI: 10.1016/j.copsyc.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 01/05/2023]
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15
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Borges AM, Leyro TM, Rosen RL, Zvolensky MJ, Farris SG. Negative urgency and ad-libitum smoking topography. Drug Alcohol Depend 2019; 201:220-226. [PMID: 31252356 PMCID: PMC6631337 DOI: 10.1016/j.drugalcdep.2019.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Negative urgency (NU), the tendency to act rashly in response to distress, is associated with negative reinforcement smoking expectancies. The study examined whether NU was associated with behavioral smoking reinforcement in the context of self-reported distress. METHOD Non-treatment seeking daily smokers (n = 124) completed an ad-libitum smoking trial. Puff topography, including puff volume, duration, velocity, and inter-puff interval, was averaged across the cigarette and evaluated at the puff level. RESULTS Multilevel models revealed a significant interaction of NU and distress as reported on the Subjective Units of Distress scale over the course of smoking in relation to puff duration and inter-puff interval. There was a significant effect of quadratic time x NU x distress on duration (b=-0.00004, p = 0.04). Smokers lower in NU reporting lower baseline distress evidenced a puff duration that decreased at a faster rate over the course of a cigarette following a quadratic function. Persistently elevated puff durations over the course of a cigarette were observed among smokers with elevated NU, regardless of basal distress. There was also a linear time x NU x distress interaction on inter-puff interval (b=-0.01, p = 0.04). Lower NU smokers, regardless of acute distress, exhibited increasing inter-puff intervals that stabilized over the course of a cigarette. Smokers with elevated NU in the context of low distress also demonstrated linearly increasing inter-puff intervals, while they demonstrated increasing intervals followed by decreasing intervals in the context of higher distress. DISCUSSION Trait NU in the context of acute distress may contribute to differences in puff topography.
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Affiliation(s)
- Allison M Borges
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Rachel L Rosen
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Anxiety and Health Research Laboratory and Substance Use Treatment Clinic, USA
| | - Samantha G Farris
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA.
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16
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Brush CJ, Olson RL, Ehmann PJ, Bocchine AJ, Bates ME, Buckman JF, Leyro TM, Alderman BL. Lower resting cardiac autonomic balance in young adults with current major depression. Psychophysiology 2019; 56:e13385. [PMID: 31020679 DOI: 10.1111/psyp.13385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/26/2019] [Accepted: 04/05/2019] [Indexed: 12/21/2022]
Abstract
Research on cardiac autonomic function in major depressive disorder (MDD) has predominantly examined cardiac vagal control and adopted a model of reciprocal autonomic balance. A proposed bivariate autonomic continuum uses cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) models, derived from normalized values of respiratory sinus arrhythmia and pre-ejection period, to more adequately index patterns of autonomic control. The purpose of this study was to assess resting levels of CAB and CAR among young adults with and without a current diagnosis of major depression. One hundred forty-two young adults (n = 65 MDD, n = 77 healthy controls; 20.8 ± 2.6 years) completed a structured diagnostic interview, cardiovascular assessment, and a maximal aerobic fitness test. The findings revealed that CAB, but not CAR, significantly predicted current MDD status (OR = 0.70, 95% CI [0.53, 0.93]), an effect that remained after controlling for aerobic fitness and body mass index. Although CAB was found to be a significant predictor of current MDD status among a sample of young adults, there remained substantial variation in autonomic control that was not captured by the traditional model of reciprocal autonomic balance.
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Affiliation(s)
- Christopher J Brush
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Ryan L Olson
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, Texas
| | - Peter J Ehmann
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Anthony J Bocchine
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey.,Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey.,Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Brandon L Alderman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey.,Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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17
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Leyro TM, Buckman JF, Bates ME. Theoretical implications and clinical support for heart rate variability biofeedback for substance use disorders. Curr Opin Psychol 2019; 30:92-97. [PMID: 31055246 DOI: 10.1016/j.copsyc.2019.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022]
Abstract
Heart rate variability (HRV) biofeedback is an accessible, cost-effective intervention that has demonstrated clinical value for numerous physical and mental health conditions; however, research on HRV biofeedback in substance use disorders (SUD) is in its nascence. We argue that HRV biofeedback may be particularly beneficial as an adjunct treatment for SUD by targeting bodily systems that are known to be disrupted by chronic substance use and are not historically the focus of psychosocial or pharmacological SUD treatment approaches. In addition to advocating for HRV biofeedback applications in SUD, we identify several gaps within the existing experimental literature, and propose new studies that could accelerate understanding of how and for whom HRV biofeedback is most likely to promote positive behavior change.
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Affiliation(s)
- Teresa M Leyro
- Rutgers University - New Brunswick, Department of Psychology, Tillett Hall, 53 Avenue E, Piscataway Township, NJ, 08854, USA.
| | - Jennifer F Buckman
- Rutgers University - New Brunswick, Department of Kinesiology and Health, 70 Lipman Drive, New Brunswick, NJ, 08854, USA; Rutgers University - New Brunswick, Center of Alcohol Studies, 607 Allison Road, Piscataway Township, NJ, 08854, USA
| | - Marsha E Bates
- Rutgers University - New Brunswick, Department of Kinesiology and Health, 70 Lipman Drive, New Brunswick, NJ, 08854, USA; Rutgers University - New Brunswick, Center of Alcohol Studies, 607 Allison Road, Piscataway Township, NJ, 08854, USA
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18
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Eckland NS, Leyro TM, Mendes WB, Thompson RJ. A multi-method investigation of the association between emotional clarity and empathy. ACTA ACUST UNITED AC 2017; 18:638-645. [PMID: 29172622 DOI: 10.1037/emo0000377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Higher emotional clarity, the extent to which people unambiguously identify, label, and describe their own emotions, is related to a host of positive intrapersonal factors but its relation to interpersonal factors is unexplored. We hypothesized that emotional clarity would be related to cognitive empathy (i.e., perceiving others' emotions) and to accurately understanding others' negative affect (NA), but not positive affect (PA), in the context of a stressful situation. After completing self-reports of trait emotional clarity and cognitive and affective empathy (i.e., one's emotional reaction to others), participants (N = 94 undergraduate students; i.e., perceivers) viewed a series of video clips of adults (i.e., targets) completing a stressful laboratory task in a previous research study. Before and after the stress task, targets reported their state NA and PA. While viewing the recordings, perceivers rated how they thought the targets were feeling at the corresponding time points. Correspondence between perceivers' and targets' affect ratings were used as indices of the outcome variable, performance-based cognitive empathy. As expected, self-reported emotional clarity was related to the self-reported cognitive, but not affective, empathy. Moreover, perceivers' emotional clarity was related to higher cognitive empathy for NA not PA after the stressful task. Our findings provide preliminary support for the importance of emotional clarity in the ability to accurately understand others' affective experiences, which has important interpersonal implications. (PsycINFO Database Record
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Affiliation(s)
- Nathaniel S Eckland
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | | | | | - Renee J Thompson
- Department of Psychological & Brain Sciences, Washington University in St. Louis
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19
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Yang MJ, Zvolensky MJ, Leyro TM. The indirect effect of panic disorder on smoking cognitions via difficulties in emotion regulation. Addict Behav 2017; 72:126-132. [PMID: 28395248 PMCID: PMC6532648 DOI: 10.1016/j.addbeh.2017.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/25/2017] [Accepted: 03/28/2017] [Indexed: 11/20/2022]
Abstract
Panic disorder (PD) and cigarette smoking are highly comorbid and associated with worse panic and smoking outcomes. Smoking may become an overlearned automatized response to relieve panic-like withdrawal distress, leading to corresponding smoking cognitions, which contribute to its reinforcing properties and difficultly abstaining. Difficulties in emotion regulation (ER) may underlie this relation such that in the absence of adaptive emotion regulatory strategies, smokers with PD may more readily rely upon smoking to manage affective distress. In the current study, the indirect relation between PD status and smoking cognitions through ER difficulties was examined among daily smokers (N=74). We found evidence for an indirect relation between PD status and negative affect, addictive and habitual smoking motives, and anticipating smoking will result in negative reinforcement and personal harm, through self-reported difficulties with ER. Our findings are aligned with theoretical models on anxiety and smoking, and suggest that reports of greater smoking cognitions may be due to ER difficulties.
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Affiliation(s)
- Min-Jeong Yang
- Rutgers, The State University of New Jersey, Department of Psychology, Tillett Hall, 53 Avenue E., Piscataway, NJ 08854, USA
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, 126 Fred J. Heyne Building, Suite 104, Houston, TX 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX 77030, USA
| | - Teresa M Leyro
- Rutgers, The State University of New Jersey, Department of Psychology, Tillett Hall, 53 Avenue E., Piscataway, NJ 08854, USA.
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20
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Manikandan S, Nillni YI, Zvolensky MJ, Rohan KJ, Carkeek KR, Leyro TM. The role of emotion regulation in the experience of menstrual symptoms and perceived control over anxiety-related events across the menstrual cycle. Arch Womens Ment Health 2016; 19:1109-1117. [PMID: 27562823 PMCID: PMC6730650 DOI: 10.1007/s00737-016-0661-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/12/2016] [Indexed: 02/06/2023]
Abstract
Hormonal variation throughout the menstrual cycle is posited to impact various physical and mental health symptoms; however, this is not observed in all women and mechanisms are not well understood. Difficulty in emotion regulation may elucidate differences that women experience in physical and mental health functioning between menstrual phases. We examined the moderating role of difficulty in emotion regulation in the relation between menstrual phase and menstrual symptom severity and perceived control over anxiety-related events, in healthy, regularly menstruating women. The participants were 37 women (Mage = 26.5, SD = 9.6). A series of regression analyses were used to examine whether individual differences in emotion regulation difficulties moderate the relation between menstrual phase and our outcomes, severity of menstrual symptoms and perceived control over anxiety-related events, using a within-subjects design. The analyses revealed that difficulty in emotion regulation significantly moderated the relation between menstrual phase and perceived control over anxiety-related events (β = -0.42, p < .05), but not menstrual symptom severity. Women who reported higher emotion regulation difficulty experienced greater differences in perceived control over anxiety-related events between menstrual phases. Specifically, women with lower difficulty in emotion regulation report greater increase in control over anxiety during the late luteal phase compared to women with higher emotion regulation difficulty. Difficulty in emotion regulation may play an important role in understanding differences in menstrual phase-associated impairments, thereby informing the development of targeted interventions for vulnerable women.
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Affiliation(s)
| | - Yael I. Nillni
- National Center for PTSD Women’s Health Sciences Division at VA Boston Healthcare system, Boston, USA,Boston University School of Medicine, Boston, USA
| | | | | | | | - Teresa M. Leyro
- Rutgers, The State University of New Jersey, New Brunsick, USA
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21
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Leyro TM, Crew EE, Bryson SW, Lembke A, Bailey SR, Prochaska JJ, Henriksen L, Fortmann SP, Killen JD, Killen DT, Hall SM, David SP. Retrospective analysis of changing characteristics of treatment-seeking smokers: implications for further reducing smoking prevalence. BMJ Open 2016; 6:e010960. [PMID: 27357195 PMCID: PMC4932265 DOI: 10.1136/bmjopen-2015-010960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/04/2016] [Accepted: 04/29/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The goal of the current study was to empirically compare successive cohorts of treatment-seeking smokers who enrolled in randomised clinical trials in a region of the USA characterised by strong tobacco control policies and low smoking prevalence, over the past three decades. DESIGN Retrospective treatment cohort comparison. SETTING Data were collected from 9 randomised clinical trials conducted at Stanford University and the University of California, San Francisco, between 1990 and 2013. PARTICIPANTS Data from a total of 2083 participants were included (Stanford, n=1356; University of California San Francisco, n=727). PRIMARY AND SECONDARY OUTCOMES One-way analysis of variance and covariance, χ(2) and logistic regression analyses were used to examine relations between nicotine dependence, cigarettes per day, depressive symptoms and demographic characteristics among study cohorts. RESULTS Similar trends were observed at both settings. When compared to earlier trials, participants in more recent trials smoked fewer cigarettes, were less nicotine-dependent, reported more depressive symptoms, were more likely to be male and more likely to be from a minority ethnic/racial group, than those enrolled in initial trials (all p's<0.05). Analysis of covariances revealed that cigarettes per day, nicotine dependence and current depressive symptom scores were each significantly related to trial (all p's<0.001). CONCLUSIONS Our findings suggest that more recent smoking cessation treatment-seeking cohorts in a low prevalence region were characterised by less smoking severity, more severe symptoms of depression and were more likely to be male and from a minority racial/ethnic group.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Erin E Crew
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Susan W Bryson
- Stanford Prevention Research Center, Stanford University, Palo Alto, California, USA
| | - Anna Lembke
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Judith J Prochaska
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Lisa Henriksen
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Stephen P Fortmann
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California, USA
- Kaiser Permanente Center for Health Research, Northwest, Portland, Oregon, USA
| | - Joel D Killen
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Diana T Killen
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Sharon M Hall
- Department of Psychiatry, San Francisco Treatment Research Center, University of California, San Francisco, California, USA
| | - Sean P David
- Department of Medicine, Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California, USA
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Abstract
BACKGROUND Distress intolerance is linked to the maintenance of panic disorder and cigarette smoking, and may underlie both problems. METHOD Smokers (n = 54; 40.7% panic disorder) were recruited for an experimental study; half were randomly assigned to 12-hour nicotine deprivation and half smoked as usual. The current investigation consisted of secondary, exploratory analyses from this larger experimental study. Four distress intolerance indices were examined as predictors of anxious responding to an emotional elicitation task (10% carbon dioxide (CO2)-enriched air challenge); anxious responding was in turn examined as a predictor of post-challenge panic and nicotine withdrawal symptoms. RESULTS The Distress Tolerance Scale (DTS) was significantly negatively associated with anxious responding to the challenge (β = -0.41, p = 0.017). The DTS was negatively associated with post-challenge increases nicotine withdrawal symptoms indirectly through the effect of anxious responding to the challenge (b = -0.485, CI95% (-1.095, -0.033)). This same indirect effect was found for post-challenge severity of panic symptoms (b = -0.515, CI95% (-0.888, -0.208)). The DTS was directly predictive of post-challenge increases nicotine withdrawal symptoms, in the opposite direction (β = 0.37, p = 0.009), but not panic symptom severity. CONCLUSIONS Anxious responding in response to stressful experiences may explain the impact of perceived distress intolerance on panic and nicotine withdrawal symptom expression.
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Affiliation(s)
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael W Otto
- Department of Psychology, Boston University, Boston, MA, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers - The State University of New Jersey, New Brunswick, NJ, USA
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Leyro TM, Hendricks PS, Hall SM. If at first you don't succeed: characterization of smokers with late smoking abstinence onset. Addict Behav 2015; 45:34-8. [PMID: 25637886 DOI: 10.1016/j.addbeh.2015.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/24/2014] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Most cigarette smoking cessation research has aimed to clarify characteristics associated with initial and sustained abstinence, with less attention paid to predictors of gaining abstinence following an initial failure. METHODS The current investigation explored pre-treatment demographic, smoking, and psychiatric characteristics related to gaining abstinence among smokers who failed to attain initial abstinence. Participants were 809 individuals enrolled in extended, 52-week, smoking cessation interventions. Of these, 287 (62.4%) failed to achieve initial abstinence. Gaining abstinence following initial abstinence failure was defined as achieving seven-day point prevalent abstinence at any post-initial abstinence assessment. RESULTS Those who gained abstinence (Gainers) were more likely to have a live-in partner (χ(2)(1, N=283)=3.8, p=.05, Cramér's V=.12), identify as Hispanic (χ(2)(1, N=281)=7.8, p<.01, Cramér's V=.17), evidence lower baseline expired breath carbon monoxide (F(1, 284)=5.7, p=.02, η(2)=.02), report less cigarette dependence (F(1, 278)=7.1, p<.01, η(2)=.03), and report past week cannabis use (χ(2)(1, N=284)=5.6, p=.02, Cramér's V=.14). A logistic regression model suggested that having a live-in partner (OR=5.14, 95% CI=1.09-3.02, p=.02) and identifying as Hispanic (OR=4.93, 95% CI=1.20-18.77, p=.03) increased the odds of gaining abstinence. DISCUSSION Having a live-in partner, Hispanic status, greater cigarette dependence, and recent cannabis use were associated with gaining abstinence. These findings provide insight into an understudied area, contributing an initial framework toward understanding gaining abstinence following initial failure.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, Rutgers University, 53 Avenue E., Piscataway, NJ 07030, USA.
| | - Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
| | - Sharon M Hall
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
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Leyro TM, Babson KA, Bonn-Miller MO. Anxiety sensitivity in relation to sleep quality among HIV-infected individuals. J Assoc Nurses AIDS Care 2014; 25:638-45. [PMID: 24759056 DOI: 10.1016/j.jana.2014.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/04/2014] [Indexed: 11/15/2022]
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25
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Leyro TM, Hall SM, Hickman N, Kim R, Hall SE, Prochaska JJ. Clinical management of tobacco dependence in inpatient psychiatry: provider practices and patient utilization. Psychiatr Serv 2013; 64:1161-5. [PMID: 24185538 PMCID: PMC5120885 DOI: 10.1176/appi.ps.201200574] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. METHODS Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. RESULTS The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman's ρ=-.30, p<.01), suggesting potential underdosing of more dependent smokers. CONCLUSIONS During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.
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Affiliation(s)
- Teresa M. Leyro
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143
| | - Sharon M. Hall
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143
| | - Norval Hickman
- State of California Tobacco-Related Disease Research Program, University of California Office of the President, Oakland
| | - Romina Kim
- College of Human Medicine, Michigan State University, East Lansing
| | - Stephen E. Hall
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
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Abstract
Distress intolerance is an important motivator of maladaptive avoidance-based coping strategies. The selection of such avoidance behaviors is also influenced by one's access to alternative emotion regulatory strategies. However, little research has examined the relative contributions of these vulnerability factors to avoidance. This study examined whether distress intolerance and access to emotion regulation strategies were uniquely (additively or interactively) associated with self-reported avoidance. Two samples-an unselected sample (n = 300) and a clinical sample (n = 100)-comprised of patients seeking treatment for unipolar mood and/or anxiety disorders were administered measures of distress intolerance, emotion regulation, and avoidance. Results of linear regression analyses indicated that distress intolerance and access to emotion regulation strategies were uniquely and additively associated with avoidance. Implications for the prevention and treatment of psychological disorders are discussed.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Proctor House 3 MS 222, Belmont, MA 02478, USA
| | - Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teresa M Leyro
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Michael W Otto
- Department of Psychology, Boston University, Boston, MA, USA
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Leyro TM, Zvolensky MJ. The interaction of nicotine withdrawal and panic disorder in the prediction of panic-relevant responding to a biological challenge. Psychol Addict Behav 2012; 27:90-101. [PMID: 22867297 DOI: 10.1037/a0029423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current investigation evaluated nicotine withdrawal symptoms elicited by 12 hours of smoking deprivation on anxious and fearful responding to bodily sensations among daily smokers with and without panic disorder (PD). It was hypothesized that smokers with PD who were experiencing greater levels of nicotine withdrawal would experience the greatest levels of fearful responding to, and delayed recovery from, a 10% carbon dioxide-enriched air (CO₂) biological challenge procedure. Participants were 58 adults who reported smoking 19.72 cigarettes daily (SD = 7.99). Results indicated that nicotine withdrawal and PD status interacted to predict greater postchallenge panic attack symptoms. Also, individuals with PD initially evidenced a quicker decrease in subjective anxiety following the challenge, but their rate of recovery decelerated over time as compared to those without PD. There was, however, no significant interaction for change in subjective anxiety pre- to postchallenge. Results are discussed in relation to the role of nicotine withdrawal in anxious and fearful responding for smokers with PD.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychiatry, University of California-San Francisco
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Howell AN, Leyro TM, Hogan J, Buckner JD, Zvolensky MJ. Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers. Addict Behav 2010; 35:1144-7. [PMID: 20719435 DOI: 10.1016/j.addbeh.2010.07.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/08/2010] [Accepted: 07/13/2010] [Indexed: 11/19/2022]
Abstract
Anxiety sensitivity, distress tolerance, and discomfort intolerance have been identified as important factors related to alcohol use motives and alcohol-related problems. Yet, these variables are highly correlated and little work has delineated whether these psychological vulnerability factors are differentially related to alcohol use motives and problems. To fill this gap in the existing literature, the present study evaluated whether anxiety sensitivity, distress tolerance, and discomfort intolerance were differentially related to high-risk alcohol use motives (i.e., coping and conformity motives) and alcohol use problems among 224 young adult, current drinkers (52.3% women; M(age)=21.18, SD=7.08). Results indicated that distress tolerance, but not anxiety sensitivity or discomfort intolerance, was significantly related to coping motives for alcohol use. Additionally, anxiety sensitivity, but not distress tolerance or discomfort intolerance, was significantly related to conformity motives for drinking. For both sets of analyses, the observed significant effects were evident above and beyond the variance accounted for by alcohol consumption level, smoking rate, negative affectivity, and non-criterion alcohol use motives. Additionally, discomfort intolerance and anxiety sensitivity each predicted alcohol use problems; effects were not attributable to negative affectivity, cigarettes smoked per day, or shared variance with distress tolerance. Findings are discussed in relation to the role of emotional sensitivity and intolerance in terms of the motivational bases for alcohol use and alcohol use problems among young adult drinkers.
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Affiliation(s)
- Ashley N Howell
- University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA
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Leyro TM, Bernstein A, Vujanovic AA, McLeish AC, Zvolensky MJ. Distress Tolerance Scale: A Confirmatory Factor Analysis Among Daily Cigarette Smokers. J Psychopathol Behav Assess 2010; 33:47-57. [PMID: 23935238 DOI: 10.1007/s10862-010-9197-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present investigation evaluated the factor structure of the Distress Tolerance Scale (DTS; Simons and Gaher 2005) among a sample of 173 (54.9% males) daily cigarette smokers (M=16.64 cigarettes per day, SD=7.83). Comparison of a single higher-order model and a hierarchical multidimensional model was conducted using confirmatory factor analyses (CFA). In addition, evaluation of the internal consistency and convergent and discriminant validity of the better-fitting model was completed. CFA of the DTS indicated a single second-order factor of distress tolerance, and four lower-order factors including Tolerance, Appraisal, Absorption, and Regulation; each factor demonstrated acceptable levels of internal consistency. In addition, the DTS displayed good convergent and discriminant validity with theoretically relevant smoking and affect variables. Results are discussed in terms of explicating the latent structure of distress tolerance, as measured by the DTS, within the context of smoking research.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington VT 05405-0134, USA,
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Leyro TM, Zvolensky MJ, Bernstein A. Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychol Bull 2010; 136:576-600. [PMID: 20565169 PMCID: PMC2891552 DOI: 10.1037/a0019712] [Citation(s) in RCA: 516] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We review theory and empirical study of distress tolerance, an emerging risk factor candidate for various forms of psychopathology. Despite the long-standing interest in and promise of work on distress tolerance for understanding adult psychopathology, there has not been a comprehensive review of the extant empirical literature focused on the construct. As a result, a comprehensive synthesis of theoretical and empirical scholarship on distress tolerance, including integration of extant research on the relations between distress tolerance and psychopathology, is lacking. Inspection of the scientific literature indicates that there are a number of promising ways to conceptualize and measure distress tolerance, as well as documented relations between distress tolerance factors and psychopathological symptoms and disorders. Although promising, there also is notable conceptual and operational heterogeneity across the distress tolerance literature. Moreover, a number of basic questions remain unanswered regarding the associations between distress tolerance and other risk and protective factors and processes, as well as its putative role(s) in vulnerability for and resilience to psychopathology. Thus, the current article provides a comprehensive review of past and contemporary theory and research and proposes key areas for future empirical study of this construct.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, University of Vermont, Burlington, VT 05405-0134, USA.
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Tart CD, Leyro TM, Richter A, Zvolensky MJ, Rosenfield D, Smits JAJ. Negative affect as a mediator of the relationship between vigorous-intensity exercise and smoking. Addict Behav 2010; 35:580-5. [PMID: 20171786 PMCID: PMC2839032 DOI: 10.1016/j.addbeh.2010.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/24/2009] [Accepted: 01/22/2010] [Indexed: 11/15/2022]
Abstract
The present cross-sectional study evaluated whether people who engage in vigorous-intensity exercise are better able to regulate negative affective states, thereby changing core maintenance factors of smoking. Participants were a community sample of adults (n = 270) who completed self-report measures of physical activity, cigarette smoking, anxiety sensitivity, and negative affect. Consistent with hypothesis, vigorous-intensity exercise was related to lower levels of cigarette smoking, accounting for 10% of the variance in smoking. Additionally, negative affect mediated the relationship between vigorous-intensity physical activity and cigarette smoking, accounting for about 12% of this relation. Furthermore, these relationships were stronger for individuals with high anxiety sensitivity than for those with low anxiety sensitivity; including anxiety sensitivity as a moderator of the mediated relationship increased the amount of variance accounted for by negative affect to 17%. The findings are discussed in relation to developing further scientific insight into the mechanisms and pathways relevant to understanding the association among vigorous-intensity exercise, smoking, and emotional vulnerability.
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Affiliation(s)
- Candyce D. Tart
- Department of Psychology, Southern Methodist University, P.O. Box 750442 Dallas, TX 75275-0442, USA
| | - Teresa M. Leyro
- Department of Psychology, University of Vermont, Room 246 John Dewey Hall, 2 Colchester Ave., Burlington VT 05405-0134, USA
| | - Ashley Richter
- Department of Psychology, University of Vermont, Room 246 John Dewey Hall, 2 Colchester Ave., Burlington VT 05405-0134, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Vermont, Room 246 John Dewey Hall, 2 Colchester Ave., Burlington VT 05405-0134, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, P.O. Box 750442 Dallas, TX 75275-0442, USA
| | - Jasper A. J. Smits
- Department of Psychology, Southern Methodist University, P.O. Box 750442 Dallas, TX 75275-0442, USA
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Johnson KA, Bonn-Miller MO, Leyro TM, Zvolensky MJ. Anxious arousal and anhedonic depression symptoms and the frequency of current marijuana use: testing the mediating role of marijuana-use coping motives among active users. J Stud Alcohol Drugs 2009; 70:543-50. [PMID: 19515294 DOI: 10.15288/jsad.2009.70.543] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The present investigation examined anxious arousal and anhedonic depression symptoms in relation to frequency of past-30-day marijuana use, as well as the role of marijuana-use coping motives in terms of mediating this relation. METHOD The present sample included current young adult marijuana users (N = 154; 48.1% female; mean [SD] age = 20.75 [5.97] years) who were recruited via study flyers and printed advertisements in local newspapers placed throughout the Burlington, VT, community. RESULTS After controlling for daily cigarette smoking rate, alcohol consumption, and gender, anxious arousal symptoms, but not anhedonic depression symptoms, were significantly and uniquely associated with the frequency of marijuana use. In addition, coping motives for marijuana use mediated the relation between anxious arousal symptoms and the frequency of current marijuana use. CONCLUSIONS These results provide novel information related to the explanatory role of marijuana-use coping motives in the relation between anxious arousal symptoms and the frequency of marijuana use among young adult active users. Clinical implications for the current findings are discussed.
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Affiliation(s)
- Kirsten A Johnson
- University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, Vermont 05405-0134, USA
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33
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Leyro TM, Zvolensky MJ, Vujanovic AA, Johnson K, Gregor K. Perceived Physical Health and Heart-Focused Anxiety Among Daily Adult Cigarette Smokers: Associations with Affect-Relevant Smoking Motives and Outcome Expectancies. Cogn Behav Ther 2009; 39:11-23. [DOI: 10.1080/16506070902767621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Teresa M. Leyro
- Department of Psychology, University of Vermont , Burlington, VT, USA
| | | | - Anka A. Vujanovic
- Department of Psychology, University of Vermont , Burlington, VT, USA
| | - Kirsten Johnson
- Department of Psychology, University of Vermont , Burlington, VT, USA
| | - Kristin Gregor
- Department of Psychology, University of Vermont , Burlington, VT, USA
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Zvolensky MJ, Johnson KA, Leyro TM, Hogan J, Tursi L. Quit-Attempt History: Relation to Current Levels of Emotional Vulnerability Among Adult Cigarette Users. J Stud Alcohol Drugs 2009; 70:551-4. [DOI: 10.15288/jsad.2009.70.551] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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35
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Gonzalez A, Zvolensky MJ, Vujanovic AA, Leyro TM, Marshall EC. An evaluation of anxiety sensitivity, emotional dysregulation, and negative affectivity among daily cigarette smokers: relation to smoking motives and barriers to quitting. J Psychiatr Res 2008; 43:138-47. [PMID: 18417153 PMCID: PMC2652862 DOI: 10.1016/j.jpsychires.2008.03.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 03/04/2008] [Accepted: 03/04/2008] [Indexed: 11/24/2022]
Abstract
The present investigation evaluated the relations between anxiety sensitivity and motivational bases of cigarette smoking, as well as barriers to quitting smoking, above and beyond concurrent substance use, negative affectivity, and emotional dysregulation among a community sample of 189 daily cigarette smokers (46% women; M(age)=24.97 years, SD=9.78). Results indicated that anxiety sensitivity was significantly related to coping, addictive, and habitual smoking motives, as well as greater perceived barriers to quitting. These effects were evident above and beyond the variance accounted for by concurrent tobacco, alcohol, and marijuana use and discernable from shared variance with negative affectivity and emotional dysregulation. Emotional dysregulation was significantly related to stimulation, habitual, and sensorimotor smoking motives and greater perceived barriers to quitting, whereas negative affectivity was only significantly related to smoking for relaxation. These findings uniquely add to a growing literature suggesting anxiety sensitivity is an important and unique cognitive factor for better understanding clinically-relevant psychological processes related to cigarette smoking.
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Leyro TM, Zvolensky MJ, Vujanovic AA, Bernstein A. Anxiety sensitivity and smoking motives and outcome expectancies among adult daily smokers: replication and extension. Nicotine Tob Res 2008; 10:985-94. [PMID: 18584462 DOI: 10.1080/14622200802097555] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present investigation examined the incremental validity of anxiety sensitivity in the context of distress intolerance in terms of predicting smoking motives and outcome expectancies. Participants were a community sample of 144 daily smokers (85 women, M (age) = 29.72 years, SD = 11.96). Results indicated that above and beyond discomfort intolerance, Axis I diagnoses, gender, volume of alcohol consumption, and average number of cigarettes smoked per day, anxiety sensitivity significantly incrementally predicted habitual, addictive, and negative affect reduction motives to smoke, as well as negative reinforcement outcome expectancies. No such incremental effects were similarly evident for distress intolerance. Findings are discussed in relation to the role of anxiety sensitivity in smoking motives and outcome expectancies.
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37
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Marshall EC, Zvolensky MJ, Vujanovic AA, Gregor K, Gibson LE, Leyro TM. Panic reactivity to voluntary hyperventilation challenge predicts distress tolerance to bodily sensations among daily cigarette smokers. Exp Clin Psychopharmacol 2008; 16:313-321. [PMID: 18729685 PMCID: PMC2556299 DOI: 10.1037/a0012752] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present investigation examined the extent to which panic reactivity to bodily sensations is related to distress tolerance (DT) among daily smokers. It was hypothesized that panic reactivity to an initial voluntary hyperventilation (i.e., whether participants met criteria for a DSM-IV panic attack; PA) would predict the relative degree of task persistence on a second hyperventilation trial (DT) above and beyond the variance accounted for by anxiety sensitivity (AS), negative affectivity (NA), cigarette smoking rate, and self-reported discomfort intolerance (DI). Participants were 95 daily smokers (58% women; M-sub(age) = 29.0, SD = 12.2) who completed a battery of questionnaires and two voluntary hyperventilation procedures. Results indicated PA status significantly predicted DT, above and beyond the theoretically relevant covariates of AS, NA, cigarettes per day, and DI ( p < .05). Such a result is consistent with theoretical models and empirical findings on emotional reactivity that suggest panic responsivity to internal cues may represent a key explanatory construct in terms of level of DT to interoceptive stimuli.
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Abstract
OBJECTIVE Despite significant advances in psychosocial treatments for substance use disorders, the relative success of these approaches has not been well documented. In this meta-analysis, the authors provide effect sizes for various types of psychosocial treatments, as well as abstinence and treatment-retention rates for cannabis, cocaine, opiate, and polysubstance abuse and dependence treatment trials. METHOD With a comprehensive series of literature searches, the authors identified a total of 34 well-controlled treatment conditions-five for cannabis, nine for cocaine, seven for opiate, and 13 for polysubstance users-representing the treatment of 2,340 patients. Psychosocial treatments evaluated included contingency management, relapse prevention, general cognitive behavior therapy, and treatments combining cognitive behavior therapy and contingency management. RESULTS Overall, controlled trial data suggest that psychosocial treatments provide benefits reflecting a moderate effect size according to Cohen's standards. These interventions were most efficacious for cannabis use and least efficacious for polysubstance use. The strongest effect was found for contingency management interventions. Approximately one-third of participants across all psychosocial treatments dropped out before treatment completion compared to 44.6% for the control conditions. CONCLUSIONS Effect sizes for psychosocial treatments for illicit drugs ranged from the low-moderate to high-moderate range, depending on the substance disorder and treatment under study. Given the long-term social, emotional, and cognitive impairments associated with substance use disorders, these effect sizes are noteworthy and comparable to those for other efficacious treatments in psychiatry.
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Affiliation(s)
- Lissa Dutra
- Center for Anxiety and Related Disorders, 648 Beacon St., Fl. 6, Boston, MA 02215, USA
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39
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McLeish AC, Zvolensky MJ, Yartz AR, Leyro TM. Anxiety sensitivity as a moderator of the association between smoking status and anxiety symptoms and bodily vigilance: replication and extension in a young adult sample. Addict Behav 2008; 33:315-27. [PMID: 17967508 PMCID: PMC2213627 DOI: 10.1016/j.addbeh.2007.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Revised: 08/17/2007] [Accepted: 09/20/2007] [Indexed: 11/13/2022]
Abstract
The present investigation evaluated the moderational role of the physical concerns dimension of anxiety sensitivity (fear of anxiety and anxiety-related states) in the relation between smoking status and panic-relevant symptoms in a young adult sample (n=222; 123 females; M(age)=22.45 years, SD=8.08). Consistent with prediction, anxiety sensitivity physical concerns moderated the association of smoking status with body vigilance and anxious arousal symptoms, such that greater anxiety sensitivity physical concerns was associated with greater panic symptoms among smokers. The observed effects were evident even after controlling for the variance accounted for by alcohol use problems and gender. Also consistent with prediction, there was no interactive effect apparent for depressive symptoms, providing evidence of explanatory specificity with respect to the anxiety variables examined. Findings are discussed with regard to the role of anxiety sensitivity in the relation between smoking and panic processes.
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Affiliation(s)
- Alison C. McLeish
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS 39216, United States
| | - Michael J. Zvolensky
- The University of Vermont, Department of Psychology, 2 Colchester Ave., Burlington, VT 05405-0134, United States
| | - Andrew R. Yartz
- The University of Vermont, Department of Psychology, 2 Colchester Ave., Burlington, VT 05405-0134, United States
| | - Teresa M. Leyro
- The University of Vermont, Department of Psychology, 2 Colchester Ave., Burlington, VT 05405-0134, United States
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40
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Zvolensky MJ, Vujanovic AA, Bernstein A, Bonn-Miller MO, Marshall EC, Leyro TM. Marijuana use motives: A confirmatory test and evaluation among young adult marijuana users. Addict Behav 2007; 32:3122-30. [PMID: 17602842 PMCID: PMC2213904 DOI: 10.1016/j.addbeh.2007.06.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 04/09/2007] [Accepted: 06/04/2007] [Indexed: 11/16/2022]
Abstract
The present investigation evaluated the measurement model and construct validity of marijuana use motives as measured by the Marijuana Motives Measure (MMM; [Simons, J., Correia, C. J., Carey, K. B., and Borsari, B. E. (1998). Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology, 45, 265-273]). Confirmatory factor analysis (CFA) and incremental tests of validity of marijuana use motives were conducted on a sample of young adult marijuana users (n=227, 127 women; M(age)=20.11, SD=4.30 years). As hypothesized, CFA analysis of marijuana use motives, as indexed by the MMM, demonstrated support for a multidimensional measurement model; specifically, a five-factor solution denoting Enhancement, Conformity, Expansion, Coping, and Social motives for marijuana use, each with satisfactory levels of internal consistency. Subsequent tests of incremental validity suggested that only certain motives were uniquely related to current substance use and cognitive-affective factors. Results are discussed in relation to refining the scientific understanding of marijuana use motives.
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Affiliation(s)
- Michael J. Zvolensky
- University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, Vermont 05405-0134
| | - Anka A. Vujanovic
- University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, Vermont 05405-0134
| | - Amit Bernstein
- Veterans Affairs Palo Alto Healthcare System, 795 Willow Park Road, Menlo Park, CA 94025
| | - Marcel O. Bonn-Miller
- University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, Vermont 05405-0134
| | - Erin C. Marshall
- University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, Vermont 05405-0134
| | - Teresa M. Leyro
- University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, Vermont 05405-0134
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41
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Otto MW, Leyro TM, Christian K, Deveney CM, Reese H, Pollack MH, Orr SP. Prediction of "fear" acquisition in healthy control participants in a de novo fear-conditioning paradigm. Behav Modif 2007; 31:32-51. [PMID: 17179530 PMCID: PMC1764631 DOI: 10.1177/0145445506295054] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Studies using fear-conditioning paradigms have found that anxiety patients are more conditionable than individuals without these disorders, but these effects have been demonstrated inconsistently. It is unclear whether these findings have etiological significance or whether enhanced conditionability is linked only to certain anxiety characteristics. To further examine these issues, the authors assessed the predictive significance of relevant subsyndromal characteristics in 72 healthy adults, including measures of worry, avoidance, anxious mood, depressed mood, and fears of anxiety symptoms (anxiety sensitivity), as well as the dimensions of Neuroticism and Extraversion. Of these variables, the authors found that the combination of higher levels of subsyndromal worry and lower levels of behavioral avoidance predicted heightened conditionability, raising questions about the etiological significance of these variables in the acquisition or maintenance of anxiety disorders. In contrast, the authors found that anxiety sensitivity was more linked to individual differences in orienting response than differences in conditioning per se.
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Affiliation(s)
- Michael W. Otto
- Department of Psychology, Boston University 64 Cummington St., Boston, MA 02215, USA
- Address correspondence to: Michael W. Otto, Ph.D., Boston University, Center for Anxiety and Related Disorders, 648 Beacon St., 5 Floor, Boston, MA 02215, Phone: (617) 353-9610, Fax: (617) 353-9609, E-mail:
| | - Teresa M. Leyro
- Department of Psychology, Boston University 64 Cummington St., Boston, MA 02215, USA
| | - Kelly Christian
- Massachusetts General Hospital and Harvard Medical School 55 Fruit St., Boston, MA 02114, USA
| | - Christen M. Deveney
- Department of Psychology, Harvard University 33 Kirkland St., Cambridge, MA 02138, USA
| | - Hannah Reese
- Massachusetts General Hospital and Harvard Medical School 55 Fruit St., Boston, MA 02114, USA
| | - Mark H. Pollack
- Massachusetts General Hospital and Harvard Medical School 55 Fruit St., Boston, MA 02114, USA
| | - Scott P. Orr
- Massachusetts General Hospital and Harvard Medical School 55 Fruit St., Boston, MA 02114, USA
- Veterans Affairs Medical Center, Manchester, NH Smyth Rd., Manchester, NH 03104, USA
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42
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Otto MW, Basden SL, Leyro TM, McHugh RK, Hofmann SG. Clinical perspectives on the combination of D-cycloserine and cognitive-behavioral therapy for the treatment of anxiety disorders. CNS Spectr 2007; 12:51-6, 59-61. [PMID: 17192764 DOI: 10.1017/s1092852900020526] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In a particular success for translational research agendas, characterization of the neuronal circuits underlying fear extinction, and basic research in animal extinction paradigms, has led to intervention studies examining the use of D-cycloserine (DCS) to enhance therapeutic learning from exposure-based cognitive-behavioral therapy (CBT). In this article, we review these intervention studies, and discuss DCS augmentation of CBT relative to more traditional combination-treatment strategies in the treatment of anxiety disorders. We offer an accounting, based on evidence for internal context effects, of current limitations in the combination of antidepressant or benzodiazepine medications with CBT and discuss the advantages of isolated-dosing strategies with DCS relative to these limitations. This strategy is contrasted with the chronic-dosing applications of DCS for schizophrenia and Alzheimer's disease, and future directions for isolated-dosing strategies are discussed.
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Affiliation(s)
- Michael W Otto
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, Boston, MA 02215, USA
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