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Objectives: Little is known about whether distress tolerance and anxiety mediate the relationship between comorbid complex posttraumatic stress disorder (CPTSD) and alcohol use among military veterans. Here, we investigated the contribution of distress tolerance and anxiety on the strength of the CPTSD and alcohol use association. We hypothesized that the impact of a two‐factor model of CPTSD derived from subscale scores on the International Trauma Questionnaire (ITQ)—namely ITQ PTSD and ITQ Disturbances in Self Organization (DSO; e.g., issues with affective regulation/self‐belief and shame)—on alcohol use severity would be mediated by anxiety but not by distress tolerance. Methods: Participants included 403 community‐dwelling United Kingdom (UK) veterans (91.64% male, Mage = 51.15 years, SD = 12.48) recruited as part of a larger, online study. Results: Findings indicated that the influence of CPTSD symptoms on alcohol use severity was mediated by anxiety, not by distress tolerance, with greater relative impact due to ITQ DSO status than ITQ PTSD status. Conclusions: We identified the mediational influence of anxiety and distress tolerance on the association between CPTSD subscales and alcohol use in UK veterans. Interventions for anxiety may be adapted for reducing problematic alcohol use and the impact of CPTSD symptoms in veterans with comorbid PTSD and alcohol use disorder. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic continues to impact global psychological wellbeing. To investigate the sustained impact of COVID-19 on wellbeing, the current study longitudinally assessed fear of COVID-19, anxiety, depression, intolerance of uncertainty, worry, sleep quality, loneliness and alcohol use during the pandemic in the United Kingdom. Timepoint 1 (T1; N = 445) took place in February 2021 following the highest number of pandemic-related deaths in the UK. Timepoint 2 (T2, N = 198) took place in June 2021 when pandemic-related deaths had declined considerably, and many had been vaccinated. At T1, COVID-19 fear predicted elevated levels of anxiety, depression, intolerance of uncertainty, worry, sleep quality and loneliness. At T2, we observed that levels of COVID-19 fear, depression, loneliness and sleep quality decreased. However, COVID-19 fear continued to predict elevated intolerance of uncertainty, worry and impaired sleep quality. These findings demonstrate the longitudinal impact of COVID-19 fear on psychological wellbeing. [ABSTRACT FROM AUTHOR]

Avoidance is an adaptive response to actual or perceived threat. However, persistent avoidance despite low likelihood of threat can become maladaptive and prevent effective psychological treatment. To examine behavioural avoidance, in-person, lab-based threat learning paradigms are typically used with relatively small sample sizes. However, such methods pose issues when in-person testing is difficult. The aim of the current study was therefore to adapt a validated lab-based threat and avoidance conditioning paradigm into an online avoidance learning task to investigate threat expectancy and avoidance remotely during the COVID-19 pandemic. An online fear and avoidance learning task was developed and administered to 119 participants who differed in the opportunity to avoid a safe stimulus. Fear and avoidance conditioning were successful and the opportunity to avoid a known safe stimulus increased threat expectancy and fear for the experimental group, relative to the control group. Such remote delivery paradigms may therefore be useful when evaluating changes in fear and avoidance • Avoidance increases threat expectancy for a previously benign stimulus. • Online delivery of an avoidance learning task. • Threat learning was dissimilar across groups in key stages. • The presence of an avoidance cue increased threat-relevance. [ABSTRACT FROM AUTHOR]