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Interplay of dysphoria and anxiety sensitivity in relation to emotion regulatory cognitions of smoking among treatment-seeking smokers
The American Journal on Addictions, 2016
There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet t... more There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet there is little understanding of how AS interplays with other affective symptomatology variables that are also related to smoking, such as dysphoria. Therefore, the current cross-sectional study evaluated the interactive effects of AS and dysphoria on emotion regulatory cognitions, including smoking negative affect reduction expectancies, perceived barriers for cessation, and smoking-specific experiential avoidance. A total of 448 adult treatment-seeking daily smokers, who responded to study advertisements, were recruited to participate in a smoking cessation treatment trial (47.8% female; Mage = 37.2, SD = 13.5). The current study utilized self-report baseline data from trial participants. After accounting for covariates, simple slope analyses revealed that AS was positively related to negative affect reduction expectancies (β = .03, p = .01), perceived barriers to cessation (β = .22, p = .002), and smoking avoidance and inflexibility (β = .07, p = .04), among smokers with lower (vs. higher) levels of dysphoria. The current findings suggest that higher levels of dysphoria may mitigate the relation between AS and emotion regulatory cognitions of smoking. The current findings highlight the unique and additive clinical relevance of AS and dysphoria regarding emotion regulatory smoking cognitions that may impede quit success. (Am J Addict 2016;25:267-274).
Cognitive Behaviour Therapy, 2015
Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial... more Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial for long-term learning and memory. Some studies suggest that people suffering from anxiety disorders show reduced BDNF relative to healthy controls. Lower BDNF is associated with impaired learning, cognitive deficits, and poor exposure-based treatment outcomes. A series of studies with rats showed that exercise elevates BDNF and enhances fear extinction. However, this strategy has not been tested in humans. In this pilot study, we randomized participants (N ¼ 9, 8 females, M Age ¼ 34) with posttraumatic stress disorder (PTSD) to (a) prolonged exposure alone (PE) or (b) prolonged exposure þ exercise (PE þ E). Participants randomized to the PE þ E condition completed a 30-minute bout of moderate-intensity treadmill exercise (70% of age-predicted HR max ) prior to each PE session. Consistent with prediction, the PE þ E group showed a greater improvement in PTSD symptoms (d ¼ 2.65) and elevated BDNF (d ¼ 1.08) relative to the PE only condition. This pilot study provides initial support for further investigation into exercise augmented exposure therapy.
Behaviour Research and Therapy, 2014
The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral ... more The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g ¼ 0.95) and at follow-up (Hedges's g ¼ 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges's g ¼ 0.64) and at follow-up (Hedges's g ¼ 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.
Psychometric Properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM–5 (PSSI–5)
Psychological Assessment, 2015
Changes to the diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition ... more Changes to the diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) create a need for valid and reliable updated assessment tools. This study examined key psychometric properties (e.g., internal consistency, test-retest reliability, interrater reliability, and convergent and discriminant validity) of the PTSD Symptom Scale Interview for DSM-5 (PSSI-5), a modified version of the PSS-I (PTSD Symptom Scale)-Interview Version for the DSM-IV. Participants were 242 urban community residents, veterans, and college undergraduates, recruited from 3 study sites, who had experienced a DSM-5 Criterion A traumatic event. The PSSI-5 demonstrated good internal consistency (α = .89) and test-retest reliability (r = .87), as well as excellent interrater reliability for the total severity score (intraclass correlation = .98) and interrater agreement for PTSD diagnosis (κ = .84). The PSSI-5 also demonstrated convergent validity with 3 measures of PTSD (i.e., Clinician-Administered PTSD Scale for DSM-5, Posttraumatic Diagnostic Scale for DSM-5, and PTSD Checklist-Specific Version; all rs > .72) and discriminant validity with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Trait scale. Receiver operating characteristic analysis yielded a cutoff score of 23 for identifying a probable PTSD diagnosis. Together, these findings indicate that the PSSI-5 is a valid and reliable instrument for assessing PTSD diagnosis and severity. (PsycINFO Database Record
Psychometric Properties of the Posttraumatic Diagnostic Scale for DSM–5 (PDS–5)
Psychological Assessment, 2015
The aim of this study was to evaluate the psychometric properties of the Posttraumatic Diagnostic... more The aim of this study was to evaluate the psychometric properties of the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5), a self-report measure of posttraumatic stress disorder (PTSD) based on diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Participants were 242 urban community residents, veterans, and college undergraduates recruited from 3 study sites who had experienced a DSM-5 Criterion A traumatic experience. The PDS-5 demonstrated excellent internal consistency (α = .95) and test-retest reliability (r = .90) and good convergent validity with the PTSD Checklist-Specific Version (r = .90) and the PTSD Symptom Scale-Interview Version for DSM-5 (PSSI-5; r = .85). The PDS-5 also showed good discriminant validity with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Trait scale (all ZH > 3.05, ps < .01). There was 78% agreement between the PDS-5 and the PSSI-5. Receiver operating characteristic analysis yielded a cutoff score of 28 for identifying a probable PTSD diagnosis. The PDS-5 is a valid and reliable measure of DSM-5 PTSD symptomatology. (PsycINFO Database Record
A Comparison between Psychosocial and Pharmacological Treatments
Social Anxiety, 2014
Exercise Augmentation of Exposure Therapy for PTSD: Rationale and Pilot Efficacy Data
Cognitive Behaviour Therapy, 2015
Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial... more Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial for long-term learning and memory. Some studies suggest that people suffering from anxiety disorders show reduced BDNF relative to healthy controls. Lower BDNF is associated with impaired learning, cognitive deficits, and poor exposure-based treatment outcomes. A series of studies with rats showed that exercise elevates BDNF and enhances fear extinction. However, this strategy has not been tested in humans. In this pilot study, we randomized participants (N = 9, 8 females, MAge = 34) with posttraumatic stress disorder (PTSD) to (a) prolonged exposure alone (PE) or (b) prolonged exposure+exercise (PE+E). Participants randomized to the PE+E condition completed a 30-minute bout of moderate-intensity treadmill exercise (70% of age-predicted HRmax) prior to each PE session. Consistent with prediction, the PE+E group showed a greater improvement in PTSD symptoms (d = 2.65) and elevated BDNF (d = 1.08) relative to the PE only condition. This pilot study provides initial support for further investigation into exercise augmented exposure therapy.
Behaviour Research and Therapy, 2014
The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral ... more The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g ¼ 0.95) and at follow-up (Hedges's g ¼ 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges's g ¼ 0.64) and at follow-up (Hedges's g ¼ 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.
Anxiety Sensitivity and Smoking Variability Among Treatment Seeking Smokers
Addictive Disorders & Their Treatment, 2015
Interplay of dysphoria and anxiety sensitivity in relation to emotion regulatory cognitions of smoking among treatment-seeking smokers
The American Journal on Addictions, 2016
There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet t... more There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet there is little understanding of how AS interplays with other affective symptomatology variables that are also related to smoking, such as dysphoria. Therefore, the current cross-sectional study evaluated the interactive effects of AS and dysphoria on emotion regulatory cognitions, including smoking negative affect reduction expectancies, perceived barriers for cessation, and smoking-specific experiential avoidance. A total of 448 adult treatment-seeking daily smokers, who responded to study advertisements, were recruited to participate in a smoking cessation treatment trial (47.8% female; Mage = 37.2, SD = 13.5). The current study utilized self-report baseline data from trial participants. After accounting for covariates, simple slope analyses revealed that AS was positively related to negative affect reduction expectancies (β = .03, p = .01), perceived barriers to cessation (β = .22, p = .002), and smoking avoidance and inflexibility (β = .07, p = .04), among smokers with lower (vs. higher) levels of dysphoria. The current findings suggest that higher levels of dysphoria may mitigate the relation between AS and emotion regulatory cognitions of smoking. The current findings highlight the unique and additive clinical relevance of AS and dysphoria regarding emotion regulatory smoking cognitions that may impede quit success. (Am J Addict 2016;25:267-274).
Cognitive Behaviour Therapy, 2015
Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial... more Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial for long-term learning and memory. Some studies suggest that people suffering from anxiety disorders show reduced BDNF relative to healthy controls. Lower BDNF is associated with impaired learning, cognitive deficits, and poor exposure-based treatment outcomes. A series of studies with rats showed that exercise elevates BDNF and enhances fear extinction. However, this strategy has not been tested in humans. In this pilot study, we randomized participants (N ¼ 9, 8 females, M Age ¼ 34) with posttraumatic stress disorder (PTSD) to (a) prolonged exposure alone (PE) or (b) prolonged exposure þ exercise (PE þ E). Participants randomized to the PE þ E condition completed a 30-minute bout of moderate-intensity treadmill exercise (70% of age-predicted HR max ) prior to each PE session. Consistent with prediction, the PE þ E group showed a greater improvement in PTSD symptoms (d ¼ 2.65) and elevated BDNF (d ¼ 1.08) relative to the PE only condition. This pilot study provides initial support for further investigation into exercise augmented exposure therapy.
Behaviour Research and Therapy, 2014
The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral ... more The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g ¼ 0.95) and at follow-up (Hedges's g ¼ 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges's g ¼ 0.64) and at follow-up (Hedges's g ¼ 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.
Psychometric Properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM–5 (PSSI–5)
Psychological Assessment, 2015
Changes to the diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition ... more Changes to the diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) create a need for valid and reliable updated assessment tools. This study examined key psychometric properties (e.g., internal consistency, test-retest reliability, interrater reliability, and convergent and discriminant validity) of the PTSD Symptom Scale Interview for DSM-5 (PSSI-5), a modified version of the PSS-I (PTSD Symptom Scale)-Interview Version for the DSM-IV. Participants were 242 urban community residents, veterans, and college undergraduates, recruited from 3 study sites, who had experienced a DSM-5 Criterion A traumatic event. The PSSI-5 demonstrated good internal consistency (α = .89) and test-retest reliability (r = .87), as well as excellent interrater reliability for the total severity score (intraclass correlation = .98) and interrater agreement for PTSD diagnosis (κ = .84). The PSSI-5 also demonstrated convergent validity with 3 measures of PTSD (i.e., Clinician-Administered PTSD Scale for DSM-5, Posttraumatic Diagnostic Scale for DSM-5, and PTSD Checklist-Specific Version; all rs > .72) and discriminant validity with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Trait scale. Receiver operating characteristic analysis yielded a cutoff score of 23 for identifying a probable PTSD diagnosis. Together, these findings indicate that the PSSI-5 is a valid and reliable instrument for assessing PTSD diagnosis and severity. (PsycINFO Database Record
Psychometric Properties of the Posttraumatic Diagnostic Scale for DSM–5 (PDS–5)
Psychological Assessment, 2015
The aim of this study was to evaluate the psychometric properties of the Posttraumatic Diagnostic... more The aim of this study was to evaluate the psychometric properties of the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5), a self-report measure of posttraumatic stress disorder (PTSD) based on diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Participants were 242 urban community residents, veterans, and college undergraduates recruited from 3 study sites who had experienced a DSM-5 Criterion A traumatic experience. The PDS-5 demonstrated excellent internal consistency (α = .95) and test-retest reliability (r = .90) and good convergent validity with the PTSD Checklist-Specific Version (r = .90) and the PTSD Symptom Scale-Interview Version for DSM-5 (PSSI-5; r = .85). The PDS-5 also showed good discriminant validity with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Trait scale (all ZH > 3.05, ps < .01). There was 78% agreement between the PDS-5 and the PSSI-5. Receiver operating characteristic analysis yielded a cutoff score of 28 for identifying a probable PTSD diagnosis. The PDS-5 is a valid and reliable measure of DSM-5 PTSD symptomatology. (PsycINFO Database Record
A Comparison between Psychosocial and Pharmacological Treatments
Social Anxiety, 2014
Exercise Augmentation of Exposure Therapy for PTSD: Rationale and Pilot Efficacy Data
Cognitive Behaviour Therapy, 2015
Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial... more Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial for long-term learning and memory. Some studies suggest that people suffering from anxiety disorders show reduced BDNF relative to healthy controls. Lower BDNF is associated with impaired learning, cognitive deficits, and poor exposure-based treatment outcomes. A series of studies with rats showed that exercise elevates BDNF and enhances fear extinction. However, this strategy has not been tested in humans. In this pilot study, we randomized participants (N = 9, 8 females, MAge = 34) with posttraumatic stress disorder (PTSD) to (a) prolonged exposure alone (PE) or (b) prolonged exposure+exercise (PE+E). Participants randomized to the PE+E condition completed a 30-minute bout of moderate-intensity treadmill exercise (70% of age-predicted HRmax) prior to each PE session. Consistent with prediction, the PE+E group showed a greater improvement in PTSD symptoms (d = 2.65) and elevated BDNF (d = 1.08) relative to the PE only condition. This pilot study provides initial support for further investigation into exercise augmented exposure therapy.
Behaviour Research and Therapy, 2014
The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral ... more The present investigation employed meta-analysis to examine the efficacy of cognitiveebehavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g ¼ 0.95) and at follow-up (Hedges's g ¼ 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges's g ¼ 0.64) and at follow-up (Hedges's g ¼ 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.
Anxiety Sensitivity and Smoking Variability Among Treatment Seeking Smokers
Addictive Disorders & Their Treatment, 2015