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Ashrafioun L, Allan NP, Stecker TA. A randomized clinical trial to assess feasibility, acceptability and preliminary effects of telehealth-delivered cognitive-behavioral therapy for perceived social isolation among individuals with opioid use disorders. Drug Alcohol Depend 2024; 258:111268. [PMID: 38520791 DOI: 10.1016/j.drugalcdep.2024.111268] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The purpose of this study was to report on feasibility, acceptability, and initial efficacy data cognitive-behavioral therapy for perceived isolation (CBT-PSI) compared to health education among individuals with opioid use disorders (OUD) reporting elevated loneliness. METHODS Participants (n = 125) with OUD reporting elevated loneliness were recruited using online advertising to participate in a telehealth-delivered randomized clinical trial. Participants received either a 6-session CBT-PSI (n = 63) or health education (n = 62). Measures assessing loneliness, quantity of social interactions, perceived social support, substance use, substance use consequences, and treatment engagement among others, were completed at baseline, post-intervention, and 1- and 2-months post-intervention. Participants also reported on treatment acceptability for both conditions. RESULTS Target enrollment was met with loneliness, social disconnectedness measures, and substance use reflecting a clinically severe sample. Retention was high (> 80%) for both conditions. Participants rated both Health Education and CBT-PSI as acceptable, helpful, and useful interventions to address loneliness and opioid use. Loneliness was reduced and quantity of social interactions and perceived social support were increased to the same extent for both conditions and across the follow-up assessments. Opioid use and overall substance use were reduced in both conditions; however, the reductions among participants received CBT-PSI were significantly greater compared to Health Education. CONCLUSIONS This study supports the feasibility and acceptability of CBT-PSI. CBT-PSI findings related to loneliness, substance use, and other social connectedness outcomes are encouraging. Additional testing of CBT-PSI in a fully-powered trial is warranted.
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Affiliation(s)
- Lisham Ashrafioun
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY 14642, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA.
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; Department of Psychiatry & Behavioral Health, Ohio State University, 370 W 9th Avenue, Columbus, OH 43210, USA
| | - Tracy A Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; School of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
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2
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Saulnier KG, Koscinski B, Flynt S, Accorso C, Allan NP. Brief observable anxiety sensitivity treatment: intervention development and a pilot randomized-controlled acceptability and feasibility trial to evaluate a brief intervention for anxiety sensitivity social concerns. Cogn Behav Ther 2024; 53:190-206. [PMID: 38014462 DOI: 10.1080/16506073.2023.2288551] [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: 06/08/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
Social anxiety disorder is one of the most prevalent anxiety disorders. There is a need to develop brief, virtual, single-session interventions targeting constructs associated with social anxiety, such as anxiety sensitivity social concerns (ASSC). ASSC is the maladaptive belief about consequences arising from observable symptoms of anxious arousal. This study was designed to evaluate the initial acceptability and feasibility of a brief ASSC reduction program (Brief Observable Anxiety Sensitivity Treatment [BOAST]) which included a single clinician-led intervention session followed by a two-week ecological momentary intervention (EMI), delivered via mobile app. Participants (N = 36) were adults with elevated ASSC who were randomly assigned to receive BOAST (n = 19) or a waitlist control (n = 17). The trial was prospectively registered at clinicaltrials.gov (NCT04859790). Results supported the acceptability of BOAST with mixed findings for feasibility. Feasibility metrics for the EMI component were below pre-defined thresholds; however, there was evidence that homework completion was associated with symptom reduction. Preliminary efficacy metrics indicated that participants in the BOAST condition had large reductions in ASSC and one measure of social anxiety at 1-month follow-up. This study provides preliminary support for the acceptability of BOAST and elucidates avenues for future clinical and research efforts.
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Affiliation(s)
- Kevin G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Sierra Flynt
- Psychology Department, Ohio University, Athens, OH, USA
| | | | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Finger Lakes, NY, USA
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3
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Jones EE, Blandl F, Kreutzer KA, Bryan CJ, Allan NP, Gorka SM. Childhood Adversity and Youth Suicide Risk: The Mediating Role of Intolerance of Uncertainty. Pers Individ Dif 2024; 216:112405. [PMID: 37860784 PMCID: PMC10583806 DOI: 10.1016/j.paid.2023.112405] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Exposure to adverse childhood experiences (ACEs) is a well-established risk factor for suicidality in adolescence and young adulthood. However, the specific mechanisms underlying this relationship remain unclear. Existing research and theoretical frameworks suggest alterations in cognitive and affective processes may account for this association. Intolerance of uncertainty (IU) exacerbates negative affect and arousal states and may contribute to sustained distress. It is therefore plausible that ACEs may be associated with high IU, and in turn, high IU may be associated with increased suicide risk. The present study directly tests this hypothesis in a cohort of youth (18-19 years) with varying ACE exposure. Participants with and without a history of trauma (N=107) completed a battery of self-report questionnaires to assess ACEs, IU, and suicide risk. Results revealed ACEs were significantly associated with both IU and suicide risk. IU and suicide risk were also correlated. Importantly, findings demonstrated a significant indirect effect of ACEs on suicide risk through IU. Findings converge with broader literature on the relationship between childhood adversity and suicidality and extend previous research by highlighting IU as a mediator of this relationship, positing IU as a potentially viable target for suicide prevention among those with a history of ACEs.
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Affiliation(s)
- Emily E Jones
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Flora Blandl
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Kayla A Kreutzer
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210
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4
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Hamrick HC, Hager NM, Middlebrooks MS, Mach RJ, Abid A, Allan NP, Judah MR. Social concerns about anxious arousal explain the association between neural responses to anxious arousal pictures and social anxiety. Biol Psychol 2024; 185:108718. [PMID: 37951347 DOI: 10.1016/j.biopsycho.2023.108718] [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: 10/18/2022] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023]
Abstract
Cognitive theories propose that social anxiety disorder involves heightened attention to anxious arousal symptoms due to worries that they may evoke rejection from others. Supporting this, studies have shown that social anxiety is related to greater attention to representations of anxious arousal and to anxiety sensitivity social concerns, which refers to sensitivity to feelings of anxious arousal during social situations. However, this has not yet been tested using neural indices of attention to images depicting anxious arousal. To examine these associations, the current study examined early and sustained attentional bias to anxious arousal images using the P2 and the late positive potential (LPP), respectively. Electroencephalogram data were collected while a non-clinical sample of undergraduate students (N = 106) viewed images of people exhibiting anxious arousal in addition to blocks of negative and neutral images from the IAPS. The neural response to anxious arousal images was isolated using residual scores (e.g., using linear regression to predict the P2 elicited by anxious arousal images from the P2 elicited by neutral images (P2neutral→AA) or negative images (P2negative→AA), then saving the unstandardized residuals). There was an indirect effect of the P2neutral→AA and P2negative→AA waveforms that was explained by anxiety sensitivity social concerns. Additionally, there was an indirect effect of both LPP waveforms on social anxiety symptoms during the early time window of the LPP (400-700 ms). At the later time window of the LPP (700-1000 ms), there was an indirect effect of the LPPneutral→AA residual waveform, but not the LPPnegative→AA, on social anxiety symptoms.
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Affiliation(s)
- Hannah C Hamrick
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States.
| | - Nathan M Hager
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, United States; Old Dominion University, Department of Psychology, Norfolk, VA, United States
| | - Morgan S Middlebrooks
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
| | - Russell J Mach
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
| | - Arooj Abid
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
| | | | - Matt R Judah
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, United States
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5
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Koscinski B, Accorso C, Albanese B, Schmidt NB, Allan NP. A replication and extension of bifactor modelling of perseverative thought in an at-risk community sample: Exploring sex differences in the structure of PT. Br J Clin Psychol 2023; 62:717-730. [PMID: 37493004 DOI: 10.1111/bjc.12434] [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: 12/29/2022] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Perseverative thought (PT) is a transdiagnostic construct associated with internalizing disorders. Bifactor models have shown that PT can be split into a general PT factor and lower-order factors for specific forms of PT, such as rumination and worry. No bifactor study to date has investigated if the structure of PT differs across sexes. METHODS The study consisted of 280 individuals recruited for a larger study targeting risk factors for suicidal ideation and behaviours. Participants completed a diagnostic interview and self-report questionnaires. RESULTS A two-factor model of PT fit best in males, whereas a bifactor model fit best in females. In a structural equation model, worry was associated with generalized anxiety disorder diagnoses in females, but not males. Rumination was associated with depressive disorder diagnoses in females, but not males. CONCLUSIONS The present study contributes to a growing literature on PT; we found that dimensionality of PT varied by sex. We also found that relations between PT factors and generalized anxiety disorder differed by sex. Sex differences in the internalizing spectrum and related risk factors need to be considered when examining the structure and function of risk factors.
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Affiliation(s)
| | | | - Brian Albanese
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Athens, Ohio, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Finger Lakes, New York, USA
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6
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Pavlacic JM, Witcraft SM, Allan NP, Gros DF. Anxiety sensitivity and social support in veterans with emotional disorders. J Clin Psychol 2023; 79:2337-2350. [PMID: 37310172 PMCID: PMC10527913 DOI: 10.1002/jclp.23554] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/11/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE An understanding of the incremental value of social support in predicting psychopathology above transdiagnostic risk factors could speak to the benefit of leveraging social factors into existing, evidence-based interventions in veterans with emotional disorders. This cross-sectional study aimed to expand our understanding of associations between domains of anxiety sensitivity and facets of psychopathology in veterans with emotional disorders. We also determined whether social support predicted psychopathology above anxiety sensitivity domains and combat exposure and explored these relationships with a path model. METHODS One hundred and fifty-six treatment-seeking veterans with emotional disorders completed diagnostic interviews and assessments of demographics, social support, symptom measures (e.g., PTSD, depression, anxiety, and stress), and transdiagnostic risk factors (i.e., anxiety sensitivity). After data screening, 150 were included in regressions. RESULTS Using regression analyses with cross-sectional data, cognitive anxiety sensitivity concerns predicted PTSD and depression above combat exposure. Cognitive and physical concerns predicted anxiety, and cognitive and social concerns predicted stress. Above combat exposure and anxiety sensitivity, social support predicted PTSD and depression. CONCLUSION Focusing on social support in tandem with transdiagnostic mechanisms in clinical samples is critical. These findings inform transdiagnostic interventions and recommendations related to incorporation of assessment of transdiagnostic factors in clinical contexts.
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Affiliation(s)
- Jeffrey M. Pavlacic
- Mental Health Service, Ralph H. Johnson, VA Healthcare System, Charleston, South Carolina, USA
- Department of Psychology & Behavioral, Sciences, Medical University of South, Carolina, Charleston, South Carolina, USA
| | - Sara M. Witcraft
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P. Allan
- Department of Psychiatry and Behavioral, Health, Ohio State University, Columbus, Ohio, USA
- VA Center of Excellence for Suicide, Prevention, VA Finger Lakes Healthcare, System, Canandaigua, New York, USA
| | - Daniel F. Gros
- Mental Health Service, Ralph H. Johnson, VA Healthcare System, Charleston, South Carolina, USA
- Department of Psychology & Behavioral, Sciences, Medical University of South, Carolina, Charleston, South Carolina, USA
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7
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Stecker T, Allan NP, Hoge C, Ashrafioun L, Conner KR. Efficacy of CBT for Treatment Seeking (CBT-TS) in Untreated Veterans and Service Members at Risk for Suicidal Behavior. J Gen Intern Med 2023; 38:2639-2646. [PMID: 36964422 PMCID: PMC10506992 DOI: 10.1007/s11606-023-08129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/17/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Military members and Veterans at-risk for suicide are often unlikely to seek behavioral health treatment. The primary aim of this study was to test the efficacy of brief CBT for Treatment Seeking (CBT-TS) to improve behavioral health treatment utilization among U.S. military service members and Veterans at-risk for suicide. METHODS A total of 841 participants who served in the U.S. military since 9/11 and who reported suicidality but were not in behavioral health treatment were recruited to participate in this trial. Participants were randomly assigned to either brief CBT-TS delivered by phone or an assessment-only control condition. Follow-up assessments were conducted at baseline and months 1, 3, 6, and 12 to track treatment utilization and symptoms. RESULTS CBT-TS resulted in significantly greater behavioral health treatment initiation within 1 month compared to the control condition (B = .93, p < .001); and the higher treatment initiation persisted for 12 months post intervention. CONCLUSIONS This study employed a low-cost, easily implementable one-session intervention administered by phone. The study provides evidence that CBT-TS is efficacious in promoting behavioral health treatment initiation in an adult population at risk for suicidal behavior and showed enduring benefits for 6-12 months. CBT-TS provides a unique strategy for treatment engagement for at-risk adults unlikely to seek treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT05077514.
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Affiliation(s)
- Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Charles Hoge
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kenneth R Conner
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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8
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Gros DF, Saulnier KG, Allan NP. Exploring trajectories in transdiagnostic behavior therapy. J Trauma Stress 2023; 36:668-681. [PMID: 37549108 PMCID: PMC10530591 DOI: 10.1002/jts.22963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/20/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 08/09/2023]
Abstract
Transdiagnostic treatments have been designed to target common processes for clusters of disorders. One such treatment, transdiagnostic behavior therapy (TBT), targets avoidance across emotional disorders, including posttraumatic stress disorder (PTSD), depressive disorders, and anxiety disorders, and has demonstrated efficacy in randomized controlled trials. The current study was designed to examine whether distinct treatment trajectories would emerge in a sample of 112 veterans receiving TBT and whether diagnostic comorbidity, baseline levels of several transdiagnostic risk factors, or treatment engagement influence trajectory membership. Growth mixture modeling revealed three distinct trajectories across depression, ds = 0.55-1.09; PTSD ds = -0.07-1.43; and panic disorder symptoms, ds = -0.13-1.09. Notably, for PTSD and panic disorder symptoms, separate classes for responders and nonresponders emerged among participants with high baseline symptom levels. Findings for the risk factors suggested that PTSD and panic nonresponders evidenced significantly higher behavioral avoidance at baseline and reduced engagement in treatment procedures and homework completion compared to responders. Together, the findings provide additional support for the use of TBT in the treatment of emotional disorders, including PTSD. Potential adaptations are discussed for patients with significantly elevated behavioral avoidance to improve treatment engagement and related outcomes.
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Affiliation(s)
- Daniel F. Gros
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kevin G. Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nicholas P. Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, New York, USA
- Department of Psychiatry, Ohio State University, Columbus, Ohio, USA
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9
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Gros DF, Allan NP, Koscinski B, Keller S, Acierno R. Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD. J Clin Psychol 2023; 79:1039-1050. [PMID: 36399326 DOI: 10.1002/jclp.23456] [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] [Received: 04/04/2022] [Revised: 09/14/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD. METHODS One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups. RESULTS Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder. CONCLUSION Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System Canandaigua, New York, USA
| | | | - Stephanie Keller
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Acierno
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Louis Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, Houston, USA
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10
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Allan NP, Gorka SM, Saulnier KG, Bryan CJ. Anxiety Sensitivity and Intolerance of Uncertainty: Transdiagnostic Risk Factors for Anxiety as Targets to Reduce Risk of Suicide. Curr Psychiatry Rep 2023; 25:139-147. [PMID: 37000403 PMCID: PMC10064604 DOI: 10.1007/s11920-023-01413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE OF REVIEW Suicide has a profound impact on individuals, families, and society. One prominent, if understudied, risk factor for suicide is anxiety. More than 70% of people with at least one suicide attempt meet diagnostic criteria for an anxiety disorder. There are several limitations to exploring the associations between anxiety and suicide using diagnosis-based classification systems. A better approach would be to consider transdiagnostic risk factors for anxiety. RECENT FINDINGS Through a negative reinforcement model of suicide, anxiety sensitivity (AS) and intolerance of uncertainty (IU) appear to exacerbate the experience of unpleasant anxiety sensations and likely contribute to chronic suicide risk as well as acute suicidal acts. Although more research is needed to clarify the mechanisms through which AS and IU confer risk, brief interventions may offer an ideal suicide prevention strategy for anxious people.
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Affiliation(s)
- Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA.
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, USA.
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | - Kevin G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, USA
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11
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Saulnier KG, Volarov M, Velimirović M, Bauer BW, Kolnogorova K, Ashrafioun L, Stecker T, Allan NP. Risk factors of suicidal behaviors in a high-risk longitudinal veteran sample: A network analysis. Suicide Life Threat Behav 2023; 53:4-15. [PMID: 36029133 DOI: 10.1111/sltb.12918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/17/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Suicide is a substantial public health burden, particularly among veterans. Risk factors have been delineated for suicide; however, the dynamic interrelations between risk factors have not been fully examined. Such research has the potential to elucidate processes that contribute to suicide risk between individuals with a past suicide attempt (attempters) and those without a past suicide attempt (nonattempters). METHODS In the current study, network analysis was used to compare networks between attempters and nonattempters in a high-risk veteran sample (N = 770; Mage = 32.3 years, SD = 6.8; 326 with a past suicide attempt) who were followed over 1 year. Networks were estimated to examine (1) concurrent relations of suicide risk factors at baseline and (2) predictability of prospective suicidal behavior (SB). RESULTS There were no differences in the overall connectivity of attempter and nonattempter networks. Perceived burdensomeness and posttraumatic stress disorder (PTSD) symptoms were most central in the attempters' network, whereas PTSD symptoms and insomnia were most central in the nonattempters' network. The risk factors prospective SB in either network. However, attempters were more likely to engage in SB over the course of the study. CONCLUSION These findings highlight the difficulty in predicting who will attempt suicide.
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Affiliation(s)
- Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, Ohio, USA.,Department of Psychiatry and Behavioral Health, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Marija Volarov
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Mina Velimirović
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Lisham Ashrafioun
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Athens, Ohio, USA.,VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA
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12
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Do C, Pizzonia KL, Koscinski B, Sánchez CM, Suhr JA, Allan NP. A preliminary examination of the Anxiety Sensitivity Index-3 factor structure in older adults. J Affect Disord 2022; 319:377-380. [PMID: 36162681 DOI: 10.1016/j.jad.2022.09.076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3), exhibits three-factor and bifactor structures for younger adults. Less is known about the scale's structure within older adult samples. METHODS We explored the ASI-3's factor structure in a sample of 135 older adults who completed the ASI-3 alongside measures of anxiety, general worry, dementia worry, and depression as part of a larger study. Structural equation modeling was used to determine the factor structure of the ASI-3 in this sample. RESULTS A bifactor model was identified and factor loadings supported a general factor and specific physical and cognitive subfactors, but not the social concerns subfactor. Whereas the general factor was associated with anxiety, general worry, dementia worry, and depression, each subfactor had differential associations with these mood/anxiety variables. In particular, the cognitive concerns subfactor was strongly associated with depression and dementia worry. LIMITATIONS Generalizability of these findings is limited by a homogenous sample. CONCLUSIONS The observed factor structure of the ASI-3 in our sample aligns with increases in physical and cognitive health concerns during aging. Associations between the cognitive concerns subfactor and dementia worry suggest that this facet of the ASI-3 may be measuring age-related health concerns rather than concerns specific to anxiety symptoms. Future studies should examine whether AS cognitive concerns and dementia worry are overlapping constructs particularly for individuals concerned about their age-related cognitive changes. Age differences in AS and its correlates should be further studied to identify better methods of assessing for AS across the lifespan.
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Affiliation(s)
- Cardinal Do
- Department of Psychology, Ohio University, Athens, OH, USA.
| | | | | | | | - Julie A Suhr
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Athens, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Finger Lakes, New York, USA
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13
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Koscinski B, Allan NP. Do Proximal Risk Factors Mediate the Impact of Affect on Symptoms of Generalized Anxiety Disorder and Major Depressive Disorder? An Extension of the Hierarchical Model of Cognitive Vulnerability. Psychopathology 2022:1-10. [PMID: 36481791 DOI: 10.1159/000527300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are among the most prevalent forms of psychopathology. The hierarchical model of cognitive vulnerability proposes that higher order risk factors explain co-occurrence among internalizing disorders, whereas lower order risk factors explain discordance. METHODS Participants (N = 646; mean age = 38.50, SD = 10.00; 49.2% female) were recruited from Amazon MTurk to complete self-report questionnaires related to psychopathology in the summer of 2020. Structural equation modeling was used to examine the relations that negative affect (NA) and positive affect (PA) share with MDD and GAD, through rumination and intolerance of uncertainty (IU), cross-sectionally. RESULTS When modeling both IU and depressive rumination together as explaining the indirect effects from affect to psychopathology, the association between NA and symptoms of MDD was explained by depressive rumination. There were no indirect effects from PA to MDD or GAD symptoms. When modeled separately, both risk factors explained the associations NA shared with MDD and GAD symptoms. CONCLUSIONS The present study extends the hierarchical model of cognitive vulnerability by finding that depressive rumination explains the association between NA and symptoms of MDD, even when controlling for IU.
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Affiliation(s)
| | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Finger Lakes, New York, USA
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14
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Brown WJ, Saulnier KG, Allan NP, Wojtalik JA, Zampogna AM, Grubaugh AL. Dropout from prolonged exposure among individuals with posttraumatic stress disorder and comorbid severe mental illness. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100405] [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: 11/29/2022] Open
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15
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Saulnier KG, Saulnier SJ, Allan NP. Cognitive risk factors and the experience of acute anxiety following social stressors: An ecological momentary assessment study. J Anxiety Disord 2022; 88:102571. [PMID: 35487044 DOI: 10.1016/j.janxdis.2022.102571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/11/2021] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022]
Abstract
To better understand how social anxiety develops, it is crucial to identify mechanisms that influence anxiety following social stressors. Anxiety sensitivity social concerns (ASSC; fear of publicly observable anxiety symptoms) and fear of negative evaluation (FNE; distress arising from concerns about negative judgment) are constructs that amplify anxiety following social stressors. However, it is unclear how ASSC and FNE influence acute anxiety following stressors in naturalistic settings. In the current study, the impact of ASSC and FNE on anxious arousal and anxious apprehension following stressors was examined in community adults (N = 83; M age = 29.66 years, SD = 12.49, 59.0% female) who completed questionnaires five times per day for two-weeks. Dynamic structural equation modeling was used to examine predictors of overall levels of anxiety as well as anxiety following social and nonsocial stressors. ASSC interacted with the presence of social stressors, such that ASSC positively predicted anxious arousal following social stressors. FNE interacted with the presence of nonsocial stressors to predict both forms of anxiety, such that FNE positively predicted anxiety following nonsocial stressors. These findings suggest ASSC may specifically amplify anxious arousal following social stressors, whereas FNE may broadly amplify anxiety following nonsocial stressors.
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Affiliation(s)
| | - Shelby J Saulnier
- Department of Adolescent Medicine, Akron Children's Hospital, Akron, OH, USA
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16
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Badour CL, Flanagan JC, Allan NP, Gilmore AK, Gros DF, Killeen T, Korte KJ, Brown DG, Kolnogorova K, Back SE. Temporal dynamics of symptom change among veterans receiving an integrated treatment for posttraumatic stress disorder and substance use disorders. J Trauma Stress 2022; 35:546-558. [PMID: 34773928 PMCID: PMC9035042 DOI: 10.1002/jts.22769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022]
Abstract
The present study examined temporal patterns of symptom change during treatment for comorbid posttraumatic stress disorders (PTSD) and substance use disorders (SUDs). We hypothesized that PTSD symptom severity would predict subsequent-session substance use and that this association would be particularly strong among patients who received an integrated treatment versus SUD-only treatment. Participants were 81 United States military veterans with current PTSD and an SUD who were enrolled in a 12-week, randomized controlled trial examining the efficacy of an integrated treatment called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) compared with cognitive behavioral relapse prevention therapy (RP). Lagged multilevel models indicated that PTSD symptom improvement did not significantly predict the likelihood of next-session substance use (likelihood of use: B = 0.03, SE = 0.02, p = .141; percentage of days using B = -0.02, SE = 0.01, p = .172. Neither substance use, B = 1.53, SE = 1.79, p = .391, nor frequency of use, B = 0.26, SE = 0.50, p = .612, predicted next-session PTSD symptom severity in either treatment condition. Stronger associations between PTSD symptoms and next-session substance use were expected given the self-medication hypothesis. Additional research is needed to better understand the temporal dynamics of symptom change as well as the specific mediators and mechanisms underlying symptom change.
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Affiliation(s)
- Christal L. Badour
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Julianne C. Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Nicholas P. Allan
- Department of Psychology, Ohio University, Athens, Ohio, USA,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, New York, USA
| | - Amanda K. Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Daniel F. Gros
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Therese Killeen
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristina J. Korte
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Delisa G. Brown
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Sudie E. Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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17
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Monopoli WJ, Huet A, Allan NP, Judah MR, Bunford N. Distinct aspects of emotion dysregulation differentially correspond to magnitude and slope of the late positive potential to affective stimuli. Cogn Emot 2022; 36:372-383. [PMID: 34775912 PMCID: PMC8860885 DOI: 10.1080/02699931.2021.2000370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/19/2022]
Abstract
ABSTRACTEmotion dysregulation (ED) is a transdiagnostic risk factor for several forms of psychopathology. One established, integrative conceptualisation of ED that has informed our understanding of psychopathology (Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation : development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54) was recently extended to account for state-level and specifically physiological aspects of ED. As such, the goal of the current study was to assess the degree to which this conceptualisation could be captured using a physiological, state-level index (i.e. the late positive potential; LPP). Participants (N=41; Mage=27.5 years, SD=11.0) completed a trait-based rating scale measure of the extended conceptualisation of ED and viewed a series of images that ranged in valence (i.e. unpleasant, pleasant, and neutral). Multilevel modelling indicated some points of convergence between rating scale scores and the LPP, and other points of divergence. Findings underscore the utility of a multi-method approach to improve understanding of key transdiagnostic characteristics across levels of analysis. Further, results are novel evidence supporting validity of the extended conceptualisation of ED.
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Affiliation(s)
| | - Ann Huet
- Department of Psychology, Ohio University, Athens, OH
| | | | - Matt R. Judah
- Department of Psychological Science, University of Arkansas, Fayetteville, AR
| | - Nóra Bunford
- ‘Lendület’ Developmental and Translational Neuroscience Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest, Hungary
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18
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Rogers AH, Garey L, Raines AM, Allan NP, Schmidt NB, Zvolensky MJ. Anxiety sensitivity and opioid use motives among adults with chronic low back pain. Exp Clin Psychopharmacol 2022; 30:23-30. [PMID: 32772532 DOI: 10.1037/pha0000381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The opioid epidemic is a significant public health crisis in the United States, and chronic pain is a leading precipitating and maintaining factor for opioid misuse. To better understand substance misuse generally, research has examined motivational models of why people use substances, and pain management and affect-driven coping are cited as primary reasons for opioid misuse. Further, research examining psychosocial predictors of opioid misuse has identified anxiety sensitivity (AS; fear of anxiety-related physical sensations) as a unique predictor of opioid misuse severity, and it is possible that AS is uniquely related to opioid pain management and coping motives, which in turn, are related to opioid misuse. Therefore, the current study examined AS as a predictor of opioid pain management and coping motives, as well as the indirect effect of AS, through opioid motives, on opioid misuse status, among 292 adults (Mage = 45.76, SD = 11.20, 68.9% female) with chronic low back pain. Results for the current study support hypotheses that AS is significantly associated with pain management and coping motives (over and above variance of pain intensity) and indirectly associated with opioid misuse status through both motives. These results highlight the importance of better understanding opioid use motives in the context of chronic pain and provide potential treatment targets to add to a growing body of literature targeting psychosocial factors for opioid misuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Lorra Garey
- Department of Psychology, University of Houston
| | - Amanda M Raines
- Department of Psychiatry, Southeast Louisiana Veterans Health Care System
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19
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Ashrafioun L, Saulnier KG, Allan NP, Bishop TM, Stecker T. Pain intensity trajectories among veterans seeking mental health treatment: Association with mental health symptoms and suicidal thoughts and behaviors. J Affect Disord 2022; 297:586-592. [PMID: 34728278 DOI: 10.1016/j.jad.2021.10.082] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/21/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to identify classes of pain intensity trajectories among veterans reporting suicidal ideation with no prior mental health treatment experience. We were interested in also assessing factors associated with the pain trajectory classes. METHODS A total 747 participants completed measures of pain, depression, suicide ideation and behaviors, insomnia, substance use, and PTSD. Follow-up assessments were completed at 1-, 3-, 6-, and 12-months post-baseline. Growth mixture modeling was conducted, and pain trajectories were modeled from baseline to month 12. RESULTS Three classes were identified: mild pain intensity that increased over time to severe pain intensity (Increasing-Severe; n = 9), low pain intensity that decreased over time (Mild-Decreasing; n = 172), and moderate pain intensity that remained relatively stable over time (Moderate-Stable; n = 566). The Moderate-Stable trajectory had more severe PTSD symptoms, more frequent depression symptoms, and more severe insomnia. The odds of endorsing suicide ideation at month 12 were significantly higher in the Moderate-Stable trajectory compared to the Mild-Decreasing trajectory. CONCLUSIONS This was the first study to assess classes of pain intensity trajectories among individuals who were treatment naïve for mental health issues. The findings suggest that a moderate stable trajectory of pain intensity over the course of 12 months is common and associated with a more severe clinical profile, including suicide ideation. This study underscores the importance of addressing pain intensity among individuals seeking mental health treatment, particularly for those with pain intensity that is moderate and stable over time.
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Affiliation(s)
- Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.
| | - Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychology, Ohio University, Athens, OH, United States
| | - Todd M Bishop
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Tracy Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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20
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Saulnier KG, Allan NP, Judah MR, Koscinski B, Hager NM, Albanese B, Knapp AA, Schmidt NB. Attentional Control Moderates the Relations between Intolerance of Uncertainty and Generalized Anxiety Disorder and Symptoms. Cognit Ther Res 2021; 45:1193-1201. [PMID: 34720260 PMCID: PMC8553219 DOI: 10.1007/s10608-021-10223-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intolerance of uncertainty (IU), perceived attentional control (AC), and poor cognitive control abilities are risk factors for anxiety; however, few studies have examined their interactive effects in relation to anxiety. A more complete understanding of interplay between IU, perceived AC, and cognitive control could inform intervention efforts. METHODS The current study examined the direct and interactive effects of IU and AC on anxiety in a sample of 280 community outpatients (M age = 36.01 years, SD = 16.17). Perceived AC was measured using self-report and cognitive control abilities were measured using a Go/No-Go task. RESULTS Findings indicated a significant IU by perceived AC interaction predicting worry and GAD diagnoses. There was a positive relation between IU and worry/GAD diagnoses that was strongest among those with high perceived AC. Perceived AC was unrelated to cognitive control abilities, and cognitive control abilities did not interact significantly with IU. Cognitive control abilities were related to worry symptoms but not to GAD diagnoses. CONCLUSIONS These results indicate that at high levels of perceived AC, individuals with elevated IU report higher levels of worry, potentially due to the conscious use of worry as an emotion regulation strategy. Clinical implications and future directions are discussed.
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Affiliation(s)
| | | | - Matt R. Judah
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | | | - Nathan M. Hager
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Brian Albanese
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Ashley A. Knapp
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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21
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Chavarria J, Ennis C, Moltisanti A, Allan NP, Taylor J. Determining the Pathways to Alcohol Use Consequences: a Chained Mediation Approach. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00272-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Allan NP, Volarov M, Koscinski B, Pizzonia KL, Potter K, Accorso C, Saulnier KG, Ashrafioun L, Stecker T, Suhr J, Allan DM. Lonely, anxious, and uncertain: Critical risk factors for suicidal desire during the COVID-19 pandemic. Psychiatry Res 2021; 304:114144. [PMID: 34364010 PMCID: PMC8442981 DOI: 10.1016/j.psychres.2021.114144] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022]
Abstract
Public health measures enacted early in response to the COVID-19 pandemic resulted in unprecedented physical isolation. Social isolation, or the objective experience of being alone, and loneliness, the subjective feeling of being lonely, are both implicated in suicidal ideation. Anxiety sensitivity (i.e., fear of somatic anxiety) and intolerance of uncertainty (distress due to uncertainty), may also be heightened in response to the pandemic increasing risk for suicidal ideation in response to social isolation and loneliness. The direct and interactive relations loneliness, anxiety sensitivity, and intolerance of uncertainty shared with suicidal ideation were examined using structural equation modeling across two samples. Sample 1 comprised 635 people (M age = 38.52, SD = 10.00; 49.0% female) recruited using Mechanical Turk in May 2020. Sample 2 comprised 435 people (M age = 34.92, SD = 14.98; 76.2% female) recruited from faculty, staff, and students at a midwestern university in June 2020. Loneliness and anxiety sensitivity were positively, uniquely associated with suicidal ideation across samples. Results of this study were cross-sectional and included only self-report measures. These findings highlight loneliness and anxiety sensitivity as important correlates of suicidal ideation. Modular treatments should be employed to target these mechanisms to reduce COVID-19-related suicidal ideation.
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Affiliation(s)
- Nicholas P Allan
- Department of Psychology, Ohio University, Athens, OH, United States; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States.
| | - Marija Volarov
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Brandon Koscinski
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kendra L Pizzonia
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kaley Potter
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Catherine Accorso
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Kevin G Saulnier
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Tracy Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Julie Suhr
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Darcey M Allan
- Department of Psychology, Ohio University, Athens, OH, United States
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23
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Schmidt NB, Allan NP, Koscinski B, Mathes BM, Eackles K, Accorso C, Saulnier KG, Allan DM, Potter K, Garey L, Suhr J, Austin M, Zvolensky MJ. COVID-19 Impact Battery: Development and Validation. J Psychopathol Behav Assess 2021; 44:326-343. [PMID: 34518734 PMCID: PMC8427558 DOI: 10.1007/s10862-021-09919-7] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/05/2022]
Abstract
In addition to impacting the physical health of millions of Americans, the novel-coronavirus (COVID-19) pandemic is a significant psychological stressor due to both the threat of the illness itself and the mitigation strategies used to contain the spread. To facilitate understanding of the impact of COVID-19, validated measures are needed. Using a stepwise procedure in line with best-practice measurement procedures, the current report summarizes the procedures employed to create the COVID-19 Impact Battery (CIB). Two independent samples recruited via Amazon Mechanical Turk (N = 175, N = 642) and a third community sample (N = 259) were used for reliability and validity testing. Validation procedures yielded a battery consisting of three scales assessing COVID-19 related behaviors, worry, and disability. The behaviors scale contains three subscales assessing stockpiling, cleaning, and avoidance. The worry subscale also contains three subscales assessing health, financial and catastrophic concerns. In addition, we created a short version of the battery (CIB-S) to allow for more flexibility in data collection. In summary, we have provided reliability and validity information for the CIB and CIB-S, demonstrating that these measures can facilitate evaluation of the broad impact of COVID-19 on mental health functioning.
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Affiliation(s)
- Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Athens, OH 45701 USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Charleston, USA
| | | | - Brittany M Mathes
- Department of Psychology, Florida State University, Tallahassee, USA
| | - Kelsey Eackles
- Department of Psychology, Ohio University, Athens, OH 45701 USA
| | | | | | - Darcey M Allan
- Department of Psychology, Ohio University, Athens, OH 45701 USA
| | - Kaley Potter
- Department of Psychology, Ohio University, Athens, OH 45701 USA
| | - Lora Garey
- Department of Psychology, University of Houston, Houston, USA
| | - Julie Suhr
- Department of Psychology, Ohio University, Athens, OH 45701 USA
| | - Megan Austin
- Department of Psychology, Ohio University, Athens, OH 45701 USA
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Ashrafioun L, Allan NP, Stecker TA. Opioid use disorder and its association with self-reported difficulties participating in social activities. Am J Addict 2021; 31:46-52. [PMID: 34472669 DOI: 10.1111/ajad.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Difficulties participating in social activities are associated with increased mortality and are underemphasized in addressing the opioid epidemic. This study assessed the association of difficulties participating in social activities and opioid use disorder (OUD) and suicidal ideation and suicide attempts and difficulties participating in social activities among individuals with OUD. METHODS Data on OUD, difficulties participating in social activities, suicidal ideation, suicide attempts, and other characteristics were assessed in 398,962 respondents from the 2008-2017 National Survey of Drug Use and Health. Logistic regressions examined the association of difficulties participating in social activities and OUD, and then among only respondents with OUD, difficulties participating in social activities and suicidal ideation and suicide attempts. RESULTS Respondents with OUD reported higher levels of difficulties participating in social activities compared with respondents without OUD (severe difficulties: odds ratio [OR] = 4.10, 95% confidence interval [CI] = 3.40-4.93). Among those with OUD, difficulties participating in social activities were associated with suicidal ideation (severe difficulties: OR = 2.45, 95% CI = 1.77-3.38), but not attempts. CONCLUSION AND SCIENTIFIC SIGNIFICANCE The findings indicate that people with OUD experience difficulties participating in social activities and these difficulties are associated with suicidal ideation. It may be important to address difficulties participating in social activities within the context of OUD treatment, potentially as it relates to suicide prevention. This is the first study utilizing 10 years of nationally representative data to assess difficulties participating in social activities, OUD, and suicidal ideation and suicide attempts. Difficulties participating in social activities represent an under-addressed, potentially important therapeutic target to address OUD.
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Affiliation(s)
- Lisham Ashrafioun
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA.,Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Tracy A Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA.,Office of Research, School of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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25
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Raines AM, Primeaux SJ, Ennis CR, Walton JL, Slaton KD, Vigil JO, Allan NP, Paulus DJ, Zvolensky MJ, Schmidt NB, Franklin CL. Posttraumatic Stress Disorder and Pain in Veterans: Indirect Association Through Anxiety Sensitivity. Cogn Ther Res 2021. [DOI: 10.1007/s10608-021-10230-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Capron DW, Allan NP, Schmidt NB. The Depression Sensitivity Index: Initial Development and Tests of Convergent and Construct Validity. J Affect Disord 2021; 287:417-426. [PMID: 33839487 DOI: 10.1016/j.jad.2021.03.051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression and suicide are prominent and increasing U.S. public health issues, which suggests novel assessment and treatment approaches are needed. Reiss' Expectancy Model of Fear, Anxiety, and Panic states that fear is based on two classes of variables, expectations and sensitivities, which has led to much research on anxiety sensitivity as a significant risk factor for later anxiety psychopathology. Major depressive disorder also includes biased expectations and sensitivities; however, a depression sensitivity rooted in Expectancy Theory has never been formalized. Uncovering depression-related sensitivities may lead to earlier risk detection and prevention before mood disorders develop. METHOD The goal of the paper was to create a Depression Sensitivity Index using exploratory factor analysis and item response theory and then conduct tests of convergent and construct validity using structural equation modeling using three independent samples. RESULTS indicated two lower order factors: 1) physical and cognitive concerns (DSPCC) and 2) social concerns (DSSC). Factors showed incremental associations with depression (DSPCC), social anxiety (both) and suicidal thoughts and behaviors (DSPCC), above and beyond anxiety sensitivity cognitive concerns. Both factors together predicted depressive disorder diagnoses LIMITATIONS: : Mostly self-report data, large percentage of non-Hispanic White participants in Study 1. CONCLUSIONS The results offer initial evidence that expectancy theory applies beyond "fear, anxiety, and panic" and that with further development depression sensitivity could be an important intervention target for prevention of major depressive disorder and suicidal thoughts and behaviors.
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Affiliation(s)
- Daniel W Capron
- Department of Psychology, University of Southern Mississippi.
| | - Nicholas P Allan
- Department of Psychology, Ohio University; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System
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Raines AM, Koscinski B, Mathes BM, Portero AK, Allan NP, Schmidt NB. Examination of a brief computerized Cognitive Anxiety Sensitivity intervention on obsessive-compulsive symptoms. Br J Clin Psychol 2021; 61 Suppl 1:93-110. [PMID: 33945163 DOI: 10.1111/bjc.12298] [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] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite the existence of several first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment. As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent reductions in OC symptoms. METHODS The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month follow-up. RESULTS The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month follow-up. CONCLUSIONS Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide initial support for the efficacy of AS interventions among individuals with elevated OC symptoms. PRACTITIONER POINTS Clinicians should consider assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an adjunct to treatment as usual.
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Affiliation(s)
- Amanda M Raines
- Department of Psychology, Florida State University, Tallahassee, Florida, USA.,Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA
| | | | - Brittany M Mathes
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Amberly K Portero
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | | | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Raines AM, Ennis CR, Allan NP, McGrew SJ, Walton JL, Rogers AH, Zvolensky MJ, Schmidt NB, Laurel Franklin C. Anxiety sensitivity and substance use: Differential levels across individuals primarily using opioids, cannabis, or stimulants. Addict Behav 2021; 116:106791. [PMID: 33497865 DOI: 10.1016/j.addbeh.2020.106791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of the current study was to compare levels of anxiety sensitivity (AS) across a treatment-seeking sample of individuals primarily using opioids, stimulants, or cannabis. Consistent with the idea that individuals high in AS may be motivated to use substances with real or perceived anxiolytic properties, it was hypothesized that individuals primarily using opioids or cannabis would evidence higher levels of AS compared to individuals primarily using stimulants. METHODS The sample consisted of 110 veterans (including 29 individuals primarily using opioids, 42 primarily using cannabis, and 39 primarily using stimulants) presenting for psychological services to a Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) specialty clinic at a large southeastern Veteran Affairs (VA) hospital. RESULTS AS levels varied by group with individuals primarily using stimulants evidencing the highest levels followed by those primarily using opioids and then those primarily using cannabis. Individuals primarily using stimulants had statistically significantly higher levels of AS physical concerns compared to individuals primarily using cannabis but not those primarily using opioids. Further, individuals who primarily use opioids did not differ from those primarily using cannabis. CONCLUSIONS Taken together, these findings call into question the notion that AS may be negatively related to the use of substances that have anxiogenic properties.
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Pizzonia KL, Koscinski B, Suhr JA, Accorso C, Allan DM, Allan NP. Insomnia during the COVID-19 pandemic: the role of depression and COVID-19-related risk factors. Cogn Behav Ther 2021; 50:246-260. [PMID: 33787448 PMCID: PMC8140992 DOI: 10.1080/16506073.2021.1879241] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/02/2020] [Accepted: 01/17/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has resulted in dramatic changes to sleep patterns and higher prevalence of insomnia, which threaten overall mental and physical health. We examined whether safety behaviors in response to COVID-19, worry in response to COVID-19, and depression predicted insomnia, with age, race, and sex as covariates. A community sample from the United States (n = 321, Mage = 40.02, SD = 10.54; 53.6% female) recruited using online crowdsourcing completed self-report measures in May of 2020 and again three months later. At baseline, our model accounted for 68.1% of the variance in insomnia, with depression as the only significant predictor (β = .70, p < .001). In the longitudinal analyses, only baseline insomnia symptoms predicted 3-month follow-up insomnia symptoms (β = .70, p < .001; 67.1% of variance). Of note, COVID-19 worry and some COVID-19 safety behaviors were related to 3-month follow-up safety behaviors, but not insomnia. Our findings demonstrated that depression is an important factor to consider for concurrent insomnia symptoms. Our results have implications regarding the development of interventions for insomnia during the COVID-19 pandemic and suggest that clinicians should consider depression when assessing for and treating insomnia symptoms.
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Affiliation(s)
| | | | - Julie A. Suhr
- Department of Psychology, Ohio University, Athens, OH, U.S
| | | | | | - Nicholas P. Allan
- Department of Psychology, Ohio University, Athens, OH, U.S
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY USA
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Mikolajewski AJ, Allan NP, Merrill L, Carter MC, Manguno-Mire G. Employing the Risk-Need-Responsivity (RNR) model and predicting successful completion in an alternative drug court program: Preliminary findings from the Orleans Parish Drug Court. J Subst Abuse Treat 2021; 131:108453. [PMID: 34098284 DOI: 10.1016/j.jsat.2021.108453] [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] [Received: 01/22/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/15/2022]
Abstract
Drug courts have been in operation for decades to provide treatment alternatives to individuals whose substance use and related behaviors have brought them into contact with the criminal justice system. As research on drug courts have evolved, it has been demonstrated that different types of offenders have different mental health and substance use treatment needs. One way of approaching treatment in court-mandated substance use treatment is by the application of the risk-need-responsivity (RNR) model (Andrews, Zinger et al., 1990). The Orleans Parish Drug Court expanded assessment and treatment services to determine whether the implementation of alternative substance use programming within a traditional drug court model improved outcomes. The goals of the current study were to describe the process of implementing risk and need principles, provide a description of client characteristics, examine the factors related to successful completion of drug court, and investigate completion rates across risk and need groups. Results demonstrated that risk and need groups differed on several demographic variables, levels of substance use, mental health concerns, and legal issues, suggesting assessment and triage procedures were successful. Comparisons between individuals who successfully completed drug court and those who were terminated prematurely also showed significant differences. Specifically, baseline age, education, substance use problems and frequency, and days in jail/prison were unique predictors of successful drug court completion. Finally, as predicted, individuals in the group with the lowest risk and need had the highest graduation rate, despite receiving less intensive services. Overall, creation of specialized treatment tracks within a traditional drug court program appears to be an effective strategy to target the wide range of offenders typical of drug court participants.
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Affiliation(s)
- Amy J Mikolajewski
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1440 Canal St., #8448, New Orleans, LA 70112, USA.
| | - Nicholas P Allan
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, 400 Fort Hill Ave, Canandaigua, NY 14424, USA.
| | - Livia Merrill
- Department of Psychology, University of Houston, 4800 Calhoun Rd, Houston, TX 77004, USA.
| | - Melissa C Carter
- 24th Judicial District Court-Deputy Judicial Administrator, Specialty Courts, 802 2nd Street, Gretna, LA 70053, USA.
| | - Gina Manguno-Mire
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1440 Canal St., #8448, New Orleans, LA 70112, USA.
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Knapp AA, Allan NP, Cloutier R, Blumenthal H, Moradi S, Budney AJ, Lord SE. Effects of anxiety sensitivity on cannabis, alcohol, and nicotine use among adolescents: evaluating pathways through anxiety, withdrawal symptoms, and coping motives. J Behav Med 2021; 44:187-201. [PMID: 32980966 PMCID: PMC7965231 DOI: 10.1007/s10865-020-00182-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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: 12/17/2019] [Accepted: 09/05/2020] [Indexed: 12/14/2022]
Abstract
Anxiety sensitivity (AS) is a promising intervention target due to its relevance to negative health behaviors broadly, and substance use specifically. The aim of the current study was to evaluate the direct and indirect pathways through which elevated AS could relate to recent substance use among a national adolescent sample recruited via social-media. As predicted, AS was indirectly associated with greater likelihood of using alcohol, cigarettes, and electronic nicotine delivery systems in the past-month through anxiety symptoms. Regarding cannabis, AS was directly related to increased likelihood of past-month cannabis use; however, the indirect relation between AS and likelihood of past-month use via anxiety symptoms was not significant. Through chained indirect effects, AS was related positively to past-month alcohol and cannabis use via anxiety symptoms and coping-related motives, and through withdrawal symptoms and coping-related motives. Study findings can be used to generate hypotheses on potential pathways through which AS could prospectively relate to substance use among youth.
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Affiliation(s)
- Ashley A Knapp
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr. 10th Floor, Chicago, IL, 60611, USA.
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA
| | - Renee Cloutier
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Heidemarie Blumenthal
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Shahrzad Moradi
- Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA
| | - Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA
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Kolnogorova K, Allan NP, Moradi S, Stecker T. Perceived burdensomeness, but not thwarted belongingness, mediates the impact of PTSD symptom clusters on suicidal ideation modeled longitudinally. J Affect Disord 2021; 282:133-140. [PMID: 33418359 DOI: 10.1016/j.jad.2020.12.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/01/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Studies examining Posttraumatic Stress Disorder symptom clusters, suicidal ideation, and variables described in the Joiner's interpersonal theory of suicidal behavior were cross-sectional. METHODS We tested whether the relation between the Posttraumatic Stress Disorder symptom clusters and suicidal ideation is mediated by perceived burdensomeness and thwarted belongingness (variables of the interpersonal theory of suicidal behavior) in military personnel with current suicidal ideation using longitudinal design. DSM-IV model with reexperiencing, avoidance, numbing, and hyperarousal clusters was used. Structural equation modelling was used to test separate models for each symptom cluster with a symptom cluster at baseline, month 1 perceived burdensomeness and thwarted belongingness, and month 3 suicidal ideation, controlling for baseline values of the month 1 and month 3 variables. RESULTS Analysis of direct non-mediation models showed that baseline reexperiencing (p = .08) and avoidance (p = .07) symptom clusters marginally predicted month 3 suicidal ideation. The mediation analyses showed indirect effects from baseline reexperiencing, avoidance, and hyperarousal to suicidal ideation at month 3 through perceived burdensomeness at month 1. Thwarted belongingness did not mediate the relations between symptom clusters and suicidal ideation. LIMITATIONS The mechanism driving development of suicidal ideation in military personnel with PTSD may be different from the mechanism in other samples. Doing a phone interview limited us to use questionnaires instead of a clinical interview. CONCLUSIONS Our findings suggest that interventions targeting perceived burdensomeness in military personnel with reexperiencing, avoidance, and hyperarousal symptoms may be beneficial to reduce suicidal ideation.
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Affiliation(s)
| | | | | | - Tracy Stecker
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY USA; College of Nursing, Medical University of South Carolina, Charleston, SC USA
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33
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Saulnier KG, Huet A, Judah MR, Allan NP. Anxiety Sensitivity and Arousal Symptom Implicit Association Task Performance: An Event-Related Potential Study of Cognitive Processing of Anxiety-Relevant Stimuli. J Affect Disord 2021; 280:7-15. [PMID: 33221610 DOI: 10.1016/j.jad.2020.11.067] [Citation(s) in RCA: 3] [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: 06/16/2020] [Revised: 09/22/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anxiety sensitivity (AS), or the fear of anxious arousal, is a transdiagnostic risk factor. Despite the proliferation of self-report research showing AS is related to anxiety, cognitive processes underlying AS are poorly understood. Specifically, AS may reflect processes related to early attentional orientation and response monitoring (reflecting automatic processes), or later engagement and assigning emotional salience towards stimuli (reflecting conscious processes). METHODS To elucidate cognitive processes underlying AS, event-related potential (ERP) components were elicited in the current study during a novel implicit association task (IAT) in which participants paired self (versus other) words with anxious arousal (versus calm) words. Analyses were then conducted in a sample of community adults (N = 67; M age 39.43, SD = 15.33, 61.2% female) to investigate the association between AS and ERP markers indicative of cognitive processing derived during the IAT. RESULTS AS was not related to performance on the arousal-IAT and that ERP components did not differ by IAT condition. AS predicted overall late positive potential (LPP) amplitude, particularly in the me/anxiety condition. Elevated IAT scores (reflecting greater ease pairing self-words with anxiety-words) predicted greater P300 amplitude in the me/anxiety condition. LIMITATIONS The sample was relatively small, and bottom-up processes were not assessed. CONCLUSIONS These findings are inconsistent with the claim that AS is related to top-down cognitive processes driving self-arousal automatic associations. Instead, AS may relate to cognitive processes regulating emotional engagement with stimuli. Further investigations of cognitive processes underlying AS are needed to inform novel interventions targeting AS.
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Affiliation(s)
| | | | - Matt R Judah
- Department of Psychological Science, University of Arkansas, Fayetteville, AR
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34
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Rogers AH, Garey L, Allan NP, Zvolensky MJ. Exploring transdiagnostic processes for chronic pain and opioid misuse among two studies of adults with chronic pain. Behav Res Ther 2020; 136:103786. [PMID: 33316580 DOI: 10.1016/j.brat.2020.103786] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 01/28/2023]
Abstract
Chronic pain is a significant public health problem associated with functional impairment, increased medical expenditures, and opioid misuse. Recent work has suggested that certain transdiagnostic psychosocial factors may be more important than pain intensity to better understand pain and opioid outcomes. Specifically, pain-related anxiety, anxiety sensitivity, emotion dysregulation, and distress tolerance have all been uniquely associated with both pain and opioid outcomes across a range of samples. Yet, no work has examined how these transdiagnostic constructs relate to pain and opioid misuse when accounting for the other constructs. Therefore, the current study employed two independent sample of adults with chronic pain to examine (1) the construct independence of each of these factors using exploratory structural equation modelling (ESEM) and (2) how each of these constructs relates to pain and opioid outcomes in latent structural models. Results from Study 1 provided empirical support for construct independence of the transdiagnostic constructs. Findings from Study 2 indicated that pain-related anxiety was most strongly related to pain intensity, interference, and pain-related negative affect, anxiety sensitivity with opioid misuse, and emotion dysregulation with all studied criterion variables. The current results highlight the importance of assessing and targeting transdiagnostic constructs among adults with pain.
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Affiliation(s)
| | - Lorra Garey
- Department of Psychology, University of Houston, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA; HEALTH Institute, University of Houston, USA.
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35
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Lozano BE, Allan NP, Gros DF, Jones J, Back SE. Treatment Goals and Alcohol Use Outcomes in Veterans With Comorbid Alcohol Dependence and Posttraumatic Stress Disorder. Am J Addict 2020; 30:131-137. [PMID: 33289961 DOI: 10.1111/ajad.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 10/09/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous research demonstrates the utility of goals in attaining improved drinking outcomes. Considerably less is known about the association between substance use goals and outcomes among persons with comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). This secondary analysis examined the association between alcohol use outcomes and participants' treatment entry substance use goals to either abstain or reduce substance use in the context of treatment for comorbid SUD/PTSD. METHODS Participants (N = 39) were treatment-seeking veterans with current alcohol dependence and PTSD. Participants completed self-report and clinician-rated measures of substance use and PTSD as part of a larger randomized controlled trial. RESULTS Participants in both goal groups (abstain; reduce) achieved significant reductions in the likelihood of drinking and the likelihood of exceeding low-risk drinking levels. The primary analysis did not identify significant differences in outcome between goal groups; however, the exploratory analysis revealed that participants with reduced use goals were more likely to drink and more likely to exceed low-risk drinking levels. CONCLUSION AND SCIENTIFIC SIGNIFICANCE The findings suggest a moderately strong association between substance use goal and drinking outcome in the current study. Although the findings did not unequivocally support abstinence as a superior treatment goal, they offer a preliminary indication that abstinence may be an overall lower-risk option. These findings expand consideration of the utility of substance use goals and suggest that clinicians should invite consideration of abstinence but may need not limit integrated treatment for SUD/PTSD based on strict adherence to abstinence, particularly if low-risk use goals are targeted. (Am J Addict 2021;30:131-137).
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Affiliation(s)
- Brian E Lozano
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Medical University of South Carolina, Charleston, South Carolina
| | | | - Daniel F Gros
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer Jones
- Medical University of South Carolina, Charleston, South Carolina
| | - Sudie E Back
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Medical University of South Carolina, Charleston, South Carolina
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Monopoli WJ, Evans SW, Benson K, Allan NP, Owens JS, DuPaul GJ, Bunford N. Assessment of a conceptually informed measure of emotion dysregulation: Evidence of construct validity vis a vis impulsivity and internalizing symptoms in adolescents with ADHD. Int J Methods Psychiatr Res 2020; 29:1-14. [PMID: 32898309 PMCID: PMC7723178 DOI: 10.1002/mpr.1826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 03/06/2020] [Accepted: 03/29/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Despite advances in understanding associations among attention-deficit hyperactivity disorder (ADHD), emotion dysregulation (ED), and related outcomes, there is incongruity between ADHD-relevant conceptualizations of ED and available measures of ED. To assess the psychometric properties of a parent-report questionnaire of ED conceptualized as deficits in the ability to modulate the (a) speed/degree of emotion escalation; (b) expression intensity; and (c) speed/degree of de-escalation. METHODS Participants were 209 adolescents with ADHD (78% male; 13.5-17.8 years old [M = 15.2 SD = 0.91]). Questionnaire items were selected from parent-report scales of ED and oppositional defiant disorder and subjected to exploratory factor analysis (EFA) and validity analyses. RESULTS The EFA revealed two factors, with speed/degree of escalation combined with intensity as factor one, and speed/degree of de-escalation as factor two. Factor one scores were related to ADHD impulsivity symptoms but not to anxiety and depression symptoms and they remained predictors of impulsivity even in the presence of self-report ED, evincing convergent, discriminant, and incremental validity. Factor two scores were related to anxiety and depression but not impulsivity, evincing convergent and discriminant validity. CONCLUSION These results inform our understanding of ADHD-relevant ED in adolescence and offer avenues for future research in measurement development, as well as for understanding ED and ADHD-related impairment.
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Affiliation(s)
- W John Monopoli
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Steven W Evans
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Kari Benson
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | | | | | - George J DuPaul
- Department of Education and Human Services, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Nóra Bunford
- 'Lendület' Developmental and Translational Neuroscience Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest, Hungary
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Smit T, Rogers AH, Garey L, Allan NP, Viana AG, Zvolensky MJ. Anxiety sensitivity and pain intensity independently predict opioid misuse and dependence in chronic pain patients. Psychiatry Res 2020; 294:113523. [PMID: 33189986 DOI: 10.1016/j.psychres.2020.113523] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/11/2020] [Accepted: 10/17/2020] [Indexed: 01/20/2023]
Abstract
The United States (US) population consumes an estimated 68% of the world's prescribed opioids each year, and over 2 million adults in the US suffer from an opioid use disorder. Although chronic pain populations are among the highest risk segments of the general population for opioid misuse and dependence, there is little understanding of individual risk characteristics that may contribute to greater risk for these outcomes among this group. The present investigation explored the concurrent role of anxiety sensitivity and pain intensity and their interaction in relation to opioid misuse and dependence among 429 adults with chronic pain (73.9% female, Mage = 38.32 years, SD = 11.07). Results revealed that both anxiety sensitivity and pain intensity were associated with opioid misuse and dependence. There was no evidence of an interaction for either outcome. Post-hoc analyses indicated that of the lower-order anxiety sensitivity facets, physical and mental incapacitation concerns contributed to variance in opioid misuse and only mental incapacitation concerns contributed to variance in opioid dependence. Overall, the current findings suggest the importance of assessing anxiety sensitivity in screening for opioid-related problems among persons with chronic pain, as it may represent a distinct pathway to poorer opioid-related outcomes among this group.
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Affiliation(s)
- Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
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Allan NP, López-Castro T, Hien DA, Papini S, Killeen TK, Gros DF, Ruglass LM, Barrett E, Back SE. Response-to-Treatment for Comorbid Post-Traumatic Stress and Substance Use Disorders: The Value of Combining Person- and Variable-Centered Approaches. J Psychopathol Behav Assess 2020; 42:725-738. [PMID: 33239837 PMCID: PMC7682732 DOI: 10.1007/s10862-020-09803-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Optimizing treatment for co-occurring post-traumatic stress disorder and substance use disorder (PTSD+SUD) is critically important. Whereas treatments have been designed that target PTSD+SUD with some success, these treatments do not benefit all. Data-driven approaches that combine person- and variable-centered methods, such as parallel process latent class growth analysis (PP-LCGA) can be used to identify response-to-treatment trajectories across both PTSD symptoms and substance use. The current study employed PP-LCGA separately in two randomized clinical trials (study 1 n = 81, Mean age = 40.4 years, SD = 10.7; study 2 n = 59, Mean age = 44.7 years, SD = 9.4) to examine PTSD symptom response and percentage of days using substances across treatment trials comparing Concurrent Treatment of PTSD and SUD using Prolonged Exposure and Relapse Prevention. Results revealed four PTSD+SUD profiles for study one and three PTSD+SUD profiles for study two. For PTSD symptoms, response trajectories could be broadly classified into treatment responders and non-responders across both studies. For substance use, response trajectories could be broadly classified into declining, moderately stable, and abstaining profiles. When considering PTSD symptoms and substance use trajectories together, profiles emerged that would have been missed had these treatment outcomes been considered separately.
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Affiliation(s)
| | | | - Denise A. Hien
- Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi, Garden City, NY
| | | | - Therese K. Killeen
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Daniel F. Gros
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Lesia M. Ruglass
- Department of Psychology, The City College of New York, New York, NY
| | - Emma Barrett
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Sudie E. Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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Raines AM, Allan NP, Franklin CL, Huet A, Constans JI, Stecker T. Correlates of Suicidal Ideation and Behaviors Among Former Military Personnel Not Enrolled in the Veterans Health Administration. Arch Suicide Res 2020; 24:517-533. [PMID: 33250005 DOI: 10.1080/13811118.2019.1660286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study sought to explore suicidal concomitants, both demographic and psychological, among former military personal. The sample included 645 veterans who are at increased risk for suicide but have not yet pursued Veterans Health Administration (VHA) services. Descriptive statistics revealed that these veterans are primarily young Caucasian males who served in the U.S. Army. In terms of psychological characteristics, the current sample reported clinically significant levels of depression, post-traumatic stress, and insomnia. Furthermore, respondents acknowledged use of various substances and high levels of perceived burdensomeness and thwarted belongingness. The demographic and psychological makeup of our sample was somewhat similar to that of VHA-connected veterans except that our sample was slightly more educated and reported less physical pain.
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Volarov M, Allan NP, Mihić L. Factor mixture modeling of anxiety sensitivity: Support for the three-class solution in a Serbian sample. Psychol Assess 2020; 32:915-927. [PMID: 32584074 DOI: 10.1037/pas0000940] [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] [Indexed: 11/08/2022]
Abstract
Anxiety sensitivity (AS) is an established transdiagnostic risk factor for emotional disorders. It is defined as the fear of anxiety sensations that arises from beliefs that those sensations can have harmful consequences on cognitive, physical, and social functioning. Thus, AS is usually considered a multidimensional construct comprised of the following dimensions: Cognitive, Physical, and Social concerns. Some studies have questioned its continuous latent structure providing taxometric evidence for its categorical nature. However, more advanced factor mixture modeling (FMM) has offered support for a hybrid, dimensional-categorial latent structure of AS. In other words, 3 qualitatively different classes were identified, with a 3-factor model within each class. In the current study, FMM was used in 2 independent Serbian samples: an adult convenient community (Facebook) sample (N = 359) and a young treatment-seeking sample (N = 342). The obtained results are fairly in line with the most recent work targeting the nature of the AS construct, using the Anxiety Sensitivity Index-3 (ASI-3). By model fit, especially comparing the 2- and 3-class solution in Sample 1, and testing external validity in Sample 2, the empirical evidence supports the 3-class solution, with classes labeled as Normative AS, Moderate AS, and High AS. Important theoretical and practical questions were raised and discussed in the article. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Marija Volarov
- Faculty of Philosophy, Department of Psychology, University of Novi Sad
| | | | - Ljiljana Mihić
- Faculty of Philosophy, Department of Psychology, University of Novi Sad
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41
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Short NA, Allan NP, Saulnier K, Preston TJ, Joiner TE, Schmidt NB. Factor Mixture Modeling of the Insomnia Severity Index among Psychology Clinic Outpatients. J Psychopathol Behav Assess 2020. [DOI: 10.1007/s10862-020-09816-5] [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: 11/30/2022]
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42
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Margherio SM, Brickner MA, Evans SW, Sarno Owens J, DuPaul GJ, Allan NP. The role of emotion regulation in alcohol use among adolescents with attention-deficit/hyperactivity disorder. Psychol Addict Behav 2020; 34:772-782. [PMID: 32271054 DOI: 10.1037/adb0000582] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the present study was to determine the role of emotion regulation in the pathway to problematic alcohol use among adolescents with attention-deficit/hyperactivity disorder (ADHD), specifically investigating the total effect of emotion regulation on problematic alcohol use and the indirect effect of emotion regulation through social skills on problematic alcohol use within a 2-wave longitudinal design. The potential protective effect of parent knowledge of these effects was assessed. Participants were 149 adolescents with ADHD (mean [M] = 15.11 years old; 78% male), and approximately 19% endorsed problematic alcohol use at Time 2. Contrary to our hypothesis, emotion regulation was not associated with subsequent problematic alcohol use without social skills in the model, and parent knowledge did not moderate this pathway. The results supported an indirect effect of emotion regulation on problematic alcohol use via social skills, although the direction of this effect was unexpected. Greater emotion regulation skills were associated with greater social skills, which in turn were associated with a higher likelihood of problematic alcohol use. Parent knowledge was protective against this indirect effect, such that the indirect effect was only present in the context of low parent knowledge. The findings delineate the roles of risk and protective factors associated with the progression from experimentation to alcohol use disorder among adolescents with ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Megan A Brickner
- Department of Psychology and Neuroscience, University of North Carolina
| | | | | | - George J DuPaul
- Department of Education and Human Services, Lehigh University
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43
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Knapp AA, Feldner M, Allan NP, Schmidt NB, Keough ME, Leen-Feldner EW. Test of an Anxiety Sensitivity Amelioration Program for at-risk youth (ASAP-Y). Behav Res Ther 2020; 126:103544. [PMID: 31981802 PMCID: PMC7784583 DOI: 10.1016/j.brat.2019.103544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/13/2019] [Revised: 12/06/2019] [Accepted: 12/29/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adult research supports the efficacy of targeting the malleable risk factor of anxiety sensitivity (AS) in preventing anxiety and related psychopathology. However, very little work has evaluated the impact of AS reduction among youth, which is unfortunate given adolescence is a "core risk" period in terms of disorder onset. METHOD The primary project aim was to test the effects of an Anxiety Sensitivity Amelioration Program for Youth (ASAP-Y) among a sample of 88 youth aged 10-14 years with elevated AS. High AS youth and a parent were randomly assigned to either the ASAP-Y, which consisted of psychoeducation and experimenter-led and parent-led exposures, or a general health information control condition. RESULTS Youth in the intervention condition sustained low AS levels across the intervention period, and although AS levels in both conditions decreased from baseline to the one-month assessment, this decrease was more pronounced at one-month for youth in the intervention condition. Further, significant indirect effects of condition on one-month anxiety and depression symptoms via reduced AS were detected. Homework compliance rates and self-report data support the acceptability of the ASAP-Y. Contrary to hypotheses, differences between conditions in emotional reactivity elicited using experimental psychopathology methods were not observed. CONCLUSIONS The current findings offer preliminary support for the ASAP-Y as an acceptable selective preventive intervention for at-risk youth, with specific anxiety- and depression-related effects through reduced AS.
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Affiliation(s)
- Ashley A Knapp
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr. 10th Floor, Chicago, IL, 60611, USA; Anxiety Research Program, Department of Psychological Science, University of Arkansas, 216 Memorial Hall, University of Arkansas, Fayetteville, AR, 72701, USA.
| | - Matthew Feldner
- Anxiety Research Program, Department of Psychological Science, University of Arkansas, 216 Memorial Hall, University of Arkansas, Fayetteville, AR, 72701, USA.
| | - Nicholas P Allan
- Factors of Emotional/Affective Risk Laboratory, Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA.
| | - Norman B Schmidt
- Anxiety and Behavioral Health Clinic, Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Meghan E Keough
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street Box 356560, Seattle, WA, 98195, USA.
| | - Ellen W Leen-Feldner
- Anxiety Research Program, Department of Psychological Science, University of Arkansas, 216 Memorial Hall, University of Arkansas, Fayetteville, AR, 72701, USA.
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Allan NP, Albanese BJ, Judah MR, Gooch CV, Schmidt NB. A multimethod investigation of the impact of attentional control on a brief intervention for anxiety and depression. J Consult Clin Psychol 2020; 88:212-225. [DOI: 10.1037/ccp0000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gros DF, Shapiro MO, Allan NP. Efficacy of transdiagnostic behavior therapy on transdiagnostic avoidance in veterans with emotional disorders. J Clin Psychol 2020; 76:31-39. [PMID: 31621905 PMCID: PMC10029096 DOI: 10.1002/jclp.22874] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To date, transdiagnostic treatments have primarily investigated treatment outcomes of general psychiatric symptomatology, rather than the specific transdiagnostic symptoms implicated in their protocols. The present study sought to address this significant gap in the literature by investigating the effect of transdiagnostic behavior therapy (TBT) on transdiagnostic avoidance. METHOD Forty-four veterans diagnosed with various emotional disorders initiated TBT, and completed diagnostic and self-report measures at pre- and posttreatment. RESULTS Participants demonstrated reliable treatment improvements in measures of situational, thought, and positive emotional avoidance, with moderate-to-large effect sizes, and in measures of physical/interoceptive avoidance with small-to-medium effect sizes. CONCLUSIONS The findings support the hypothesized effect of TBT in self-report measures of four types of transdiagnostic avoidance in participants diagnosed with various emotional disorders. These findings contribute to the growing literature on the potential benefits of the transdiagnostic approaches to address symptomatology across diagnoses.
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Affiliation(s)
- Daniel F. Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Oglesby Shapiro
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Allan NP, Holm-Denoma J, Conner KR, Zuromski KL, Saulnier KG, Stecker T. Profiles of Risk for Suicidal Behavior in Past and Current United States Military Personnel: Latent Profile Analysis of Current Risk Factors. Arch Suicide Res 2020; 24:1-17. [PMID: 30118632 DOI: 10.1080/13811118.2018.1506843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Person-centered approaches are underutilized to identify people with shared risk profiles. In this study, an at-risk sample of 773 past/current military personnel (Mage = 31.3 years, SD = 6.8) with current ideation (90.6%) and/or a prior suicide attempt (43.9%) were assessed using latent profile analysis. Variables included prior suicide attempts, suicidal ideation, alcohol/drug use, insomnia, depression, belongingness, burdensomeness, and post-traumatic stress disorder symptoms. Three classes emerged: Low Symptoms (N = 502), Elevated Suicidality (N = 176), and Elevated Substance Use (N = 95). At 1-month follow-up, the Elevated Suicidality and Elevated Substance Use classes had the highest odds of suicidal behavior. The finding concerning the Elevated Substance Use class suggests it may represent a distinct short-term risk group in military personnel.
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Allan NP, Ashrafioun L, Kolnogorova K, Raines AM, Hoge CW, Stecker T. Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use. Depress Anxiety 2019; 36:1072-1079. [PMID: 31475423 DOI: 10.1002/da.22954] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 10/18/2018] [Revised: 06/18/2019] [Accepted: 07/27/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high-risk sample of military personnel not active in mental health treatment. METHODS Current and former military personnel at risk for suicide (N = 545; M age = 31.91 years, standard deviation = 7.27; 88.2% male) completed self-report measures of PTSD symptoms, past 30 days heavy alcohol use, opioid use, marijuana use, and current suicidal ideation via telephone at baseline and 1, 3, 6, and 12 months later. PTSD symptoms and the substance use variables (and relevant covariates) were entered as predictors of changes in PTSD symptoms, the likelihood of suicidal ideation, suicidal ideation severity, and the likelihood of suicidal behavior during the 11-month follow-up period. RESULTS PTSD symptoms predicted PTSD symptoms 1 month later. PTSD symptoms and marijuana use predicted the likelihood of suicidal ideation 1 month later and suicidal behavior during the 11-month follow-up period. The interaction between PTSD symptoms and marijuana use significantly predicted increased PTSD symptoms over time and suicidal behavior. At high, but not low levels of PTSD symptoms, more days using marijuana predicted increased PTSD symptoms over time and the likelihood of suicidal behavior. CONCLUSIONS Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD.
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Affiliation(s)
| | - Lisham Ashrafioun
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.,South Central Mental Illness Research, Education, and Clinical Center (MIRECC), New Orleans, Louisiana
| | - Charles W Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland.,Behavioral Health Division, Office of the Army Surgeon General, Falls Church, Virginia
| | - Tracy Stecker
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York.,College of Nursing, Medical University of South Carolina, Charleston, South Carolina
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Bauer BW, Martin RL, Allan NP, Fink-Miller EL, Capron DW. An Investigation into the Acquired Capability for Suicide. Suicide Life Threat Behav 2019; 49:1105-1118. [PMID: 30091246 DOI: 10.1111/sltb.12502] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 07/11/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The acquired capability for suicide (ACS) is one of the most important breakthroughs in suicide research. ACS refers to an individual's increased fearlessness about death over time from experiencing painful and provocative events (PPE) and is based on opponent-process theory-a habituation model. Few studies have investigated how ACS develops and found that ACS remained relatively stagnant. METHOD This study sought to expand these findings by observing how ACS develops in two cross-sectional data sets involving high-risk nonclinical samples of physicians (n = 419) and veterinary students (n = 124). Participants completed online questionnaires assessing both general PPEs (e.g., witnessing abuse) and job-specific PPEs (e.g., exposure to euthanasia), as well as ACS. RESULTS Our results partially replicated prior findings indicating that more PPEs do not significantly affect ACS. CONCLUSIONS Limitations of this study include the use of cross-sectional data and self-report measures. These results, in combination with existing models of habituation, suggest ACS may not progress linearly.
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Affiliation(s)
- Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Rachel L Martin
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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49
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Allan NP, Gros DF, Lancaster CL, Saulnier KG, Stecker T. Heterogeneity in Short-Term Suicidal Ideation Trajectories: Predictors of and Projections to Suicidal Behavior. Suicide Life Threat Behav 2019; 49:826-837. [PMID: 29938818 DOI: 10.1111/sltb.12480] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/02/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Little is known about suicidal ideation stability, including whether stability is heterogeneous or homogeneous between individuals. Studies of this kind are necessary to understand the progression from suicidal ideation to action. METHOD This study examined suicidal ideation trajectories, using growth mixture modeling, in a sample of 359 past/current military service members (M age = 32.1 years, SD = 7.7; 88.3% male). Self-reported suicidal ideation information was collected at baseline and follow-up sessions at months 1, 3, 6, and 12. Following extraction of the best-fitting solution, predictors of trajectory status were examined and trajectory status was used to predict suicidal behavior between baseline and month 12 assessments. RESULTS Results revealed four trajectories, Low-Stable (n = 125), Moderate-Stable (n = 101), High-Stable (n = 76), and High-Rapidly Declining (n = 57). In general, the High-Stable trajectory had the highest levels of perceived burdensomeness, thwarted belongingness, PTSD symptoms, and drug use. The High- and Moderate-Stable trajectories had the highest rates of suicidal behavior between baseline and month 12. CONCLUSIONS Suicidal ideation, even in individuals with elevated ideation, is not a homogeneous construct over time. Stability of suicidal ideation might be an important risk factor, even if ideation is only moderately elevated.
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Affiliation(s)
| | - Daniel F Gros
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Cynthia L Lancaster
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | | | - Tracy Stecker
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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50
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Short NA, Allan NP, Oglesby ME, Moradi S, Schmidt NB, Stecker T. Prospective associations between insomnia symptoms and alcohol use problems among former and current military service personnel. Drug Alcohol Depend 2019; 199:35-41. [PMID: 30981047 DOI: 10.1016/j.drugalcdep.2019.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/20/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite evidence that insomnia symptoms exacerbate alcohol use disorder symptoms, there is a dearth of prospective research testing bidirectional associations between these variables. Furthermore, no studies have prospectively examined these associations among military personnel, a vulnerable population for sleep- and alcohol-related problems. Thus, the current study examined whether insomnia symptoms prospectively predicted increased alcohol use disorder symptoms among a sample of military service members and veterans over a 6-month follow-up period, as well as whether alcohol use disorder symptoms led to increases in insomnia. METHOD Hypotheses were tested among a sample of 274 current and past military service members who participated in a baseline and 6-month assessment using self-report measures. RESULTS Path analyses revealed that insomnia symptoms significantly prospectively predicted increased month-6 heavy drinking and alcohol-related problems, but not days drinking or being bothered by drinking. None of the alcohol variables significantly predicted insomnia. CONCLUSION Results support a model in which insomnia symptoms exacerbate alcohol use disorder symptoms, specifically heavy drinking and alcohol-related problems. Future research should seek to examine these findings in diverse populations and test potential mechanisms and clinical implications of these results.
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Affiliation(s)
- Nicole A Short
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL, 32304, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Porter Hall 200, Athens, OH, 45701, USA
| | - Mary E Oglesby
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL, 32304, USA
| | - Shahrzad Moradi
- Department of Psychology, Ohio University, Porter Hall 200, Athens, OH, 45701, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL, 32304, USA.
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC, 29425, USA
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