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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).

Objective Accurate threat appraisal is central to survival. In the case of the coronavirus pandemic, accurate threat appraisal is difficult due to incomplete medical knowledge as well as complex social factors (e.g., mixed public health messages). The purpose of this study was to evaluate the degree to which individuals accurately perceive COVID-19 infection rates and to explore the role of COVID-19 threat perception on emotional and behavioral responses both cross sectionally and prospectively. Methods: A community sample (N = 249) was assessed using online crowdsourcing and followed for one month. COVID-19 threat appraisal was compared with actual COVID-19 infection rates and deaths at the time of data collection in each participant's county and state. It was predicted that actual versus perceived COVID-19 infection rates would only be modestly associated. Relative to actual infection rates, perceived infection rates were hypothesized to be a better predictor of COVID-related behaviors, distress, and impairment. Results: Findings indicated that relative to actual infection, perceived infection was a better predictor of COVID-related outcomes cross sectionally and longitudinally. Interestingly, actual infection rates were negatively related to behaviors cross sectionally (e.g., less stockpiling). Prospectively, these variables interacted to predict avoidance behaviors over time such that the relationship between perceived infection and avoidance was stronger as actual infection increased. Conclusions: These data suggest that perceived COVID-19 infection is significantly associated with COVID-related behaviors, distress and impairment whereas actual infection rates have a less important and perhaps even paradoxical influence on behavioral responses to the pandemic.

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.

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).

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).

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.

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.

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.

This study sought to examine the effect of general PTSD symptoms as well as specific PTSD symptom clusters on suicidal ideation and suicidal attempts. We first compared a correlated factors solution consistent with the DSM-5 symptom clusters for PTSD with a bifactor solution comprising a General PTSD factor and orthogonal specific factors. Using the best fitting model (i.e., bifactor solution), we then investigated the effect of specific PTSD symptom clusters on severity of suicidal ideation and suicide attempts above and beyond the effect of general PTSD symptoms. A sample of 773 veterans who have never sought professional mental health treatment were screened for suicidal ideation within the past two weeks. One month after the baseline measurement, the participants completed a follow-up assessment, again by telephone. A bi-factor solution was used to account for a general PTSD factor as well as the specific DSM-5 PTSD symptom clusters. After controlling for baseline suicidal ideation and behavior, it appeared that the Anxious Arousal factor was predictive of changes in the magnitude of severity of suicidal ideation and the General PTSD factor was predictive of the onset of new suicidal behavior at the one-month follow-up. Additionally, the Re-experiencing factor of PTSD also significantly predicted new suicidal behavior at the one-month follow-up. These results suggest that it may beneficial for clinicians, who are assessing individuals with PTSD for suicidality, to be aware of the frequency, duration, and content of their clients’ repetitive, intrusive thoughts as these thoughts may increase their capability to inflict non-lethal or lethal forms of self-injury.

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.

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.

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.

Integrated exposure-based interventions to treat substance use disorders (SUD) and posttraumatic stress disorder (PTSD) may not be widely utilized, in part, because of clinician concerns that such interventions will worsen symptomatology and lead to treatment dropout. In order to address this question, the current pilot study examined whether participants' ratings of craving and distress following imaginal exposure predicted increased substance use, PTSD severity, and treatment dropout. Participants (N = 46) were U.S. military Veterans who met criteria for current SUD and PTSD. Subjective ratings of craving and distress, and past-week substance use and PTSD symptom severity were assessed at each treatment session. Multilevel modeling tested whether lagged ratings of craving and distress predicted the following week's frequency of substance use and PTSD severity. Discrete time survival analysis, using proportional odds Cox ratio, examined whether craving and distress ratings predicted treatment dropout. The findings revealed that neither craving nor distress following imaginal exposure were associated with the following week's substance use or PTSD severity. However, participants with higher craving and distress were more likely to drop out before completing treatment. Future research is needed to develop strategies to increase treatment retention for individuals at-risk for treatment dropout and identify mechanisms that account for the association between in-session ratings of craving and distress and dropout.

OBJECTIVE: A substantial amount of individuals with substance use disorders (SUD) also meet criteria for posttraumatic stress disorder (PTSD). Prolonged exposure (PE) is an effective, evidenced-based treatment for PTSD, but there is limited data on its use among individuals with current alcohol or drug use disorders. This study evaluated the efficacy of an integrated treatment that incorporates PE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure or COPE) among veterans. METHOD: Military veterans (N = 81, 90.1% male) with current SUD and PTSD were randomized to 12 sessions of COPE or Relapse Prevention (RP). Primary outcomes included the Clinician-Administered PTSD Scale (CAPS), PTSD Checklist-Military version (PCL-M), and the Timeline Follow-back (TLFB). RESULTS: On average, participants attended 8 out of 12 sessions and there were no group differences in retention. Intent-to-treat analyses revealed that COPE, in comparison to RP, resulted in significantly greater reductions in CAPS (d = 1.4, p

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).

Anxiety sensitivity (AS), or the fear of anxious arousal, is a transdiagnostic risk factor predictive of a wide variety of affective disorders. Whereas AS is widely studied via self-report, the neurophysiological correlates of AS are poorly understood. One specific issue this may help resolve is well-established gender differences in mean levels of AS. The current study evaluated late positive potential (LPP) for images designed to target AS during an emotional picture viewing paradigm. Structural equation modeling was used to examine convergent and discriminant validity for self-report AS and the LPP for AS images, considering gender as a potential moderator. Analyses were conducted in an at-risk sample of 251 community adults (M age = 35.47, SD = 15.95; 56.2% female; 53.6% meeting for a primary Axis I anxiety or related disorder). Findings indicated that the AS image LPP was significantly, uniquely associated with self-report AS, controlling for the LPP for unpleasant images, in females only. Mean levels of AS self-report as well as the AS image LPP were higher in females than in males. These findings provide initial support for the AS image LPP as a useful neurophysiological correlate of AS self-report in females. These findings also provide support for a biological cause for gender differences in AS. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent and commonly co-occur. The dual diagnosis of PTSD/AUD is associated with serious negative sequalae and there are currently no effective pharmacological treatments for this comorbidity. Both PTSD and AUD are characterized by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which helps modulate stress reactivity. Oxytocin, a neuropeptide that attenuates HPA axis dysregulation, may be beneficial for individuals with co-occurring PTSD/AUD. Thus, the current study examined the effects of intranasal oxytocin (40 IU) as compared to placebo on stress reactivity (e.g., cortisol) as well as subjective alcohol craving in response to a laboratory stress task (Trier Social Stress Task). Participants were 67 male U.S. military veterans with current PTSD and AUD (oxytocin n=32, placebo n=35; overall mean Age=49.06 years). Baseline cortisol levels were examined as a moderator of outcome. The findings revealed that oxytocin marginally attenuated cortisol reactivity in response to the stress task. Furthermore, oxytocin’s effect was moderated by baseline cortisol level, such that oxytocin mitigated cortisol reactivity to a greater extent among participants with higher, as compared to lower, baseline cortisol. Oxytocin did not reduce craving. Although preliminary, the findings are the first to examine oxytocin in co-occurring PTSD/AUD. The findings from this study contribute to the growing literature examining the potential utility of oxytocin among individuals with psychiatric disorders, such as PTSD and substance use disorders. NCT02058251. Keywords: PTSD; alcohol; craving; comorbidity; oxytocin; social stress

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.

Background The suicide rate in the Unites States continues to increase suggesting novel intervention strategies are needed. Anxiety sensitivity (AS), or a fear of anxiety-related sensations, is a suicide risk factor that can be ameliorated via a single-session, computerized intervention called the Cognitive Anxiety Sensitivity Treatment (CAST). Results from randomized controlled trials have demonstrated that reductions in suicidal ideation (SI) due to CAST were mediated by AS reductions. However, a more detailed analysis of the mechanisms of SI reduction due to AS interventions is needed to further our understanding of theoretical models of AS and suicide, and to refine AS treatments. Methods Participants (N = 74) with co-occurring anxiety pathology and SI were randomized to a single-session computerized treatment (CAST + cognitive bias modification) or a control intervention. Assessments were conducted immediately post treatment, and at 1 month and 4 month follow-ups. Results Chained mediation models revealed significant reductions in SI (month 4 follow-up) through AS (post-treatment) and subsequently anxiety symptoms (month 1 follow-up), but not depressive symptoms. There were no direct mediation effects through either AS or anxiety or depressive symptoms. Limitations Limitations include self-report assessment of symptoms, a sample of only individuals with a diagnosed anxiety pathology, and exploratory nature of anxiety/depression dimension analyses. Conclusions Results of the current study help clarify the mechanistic pathways of SI reduction due to an AS intervention, and suggest future work attempting to increase the efficacy of AS interventions should consider the potentially important role of downstream mechanisms that follow AS reduction.

Distress intolerance (DI), a trait-like individual difference reflective of the inability to endure aversive affective states, is relevant to multiple forms of psychopathology, but its relations to theoretically-relevant neurobiological systems has received little attention. Altered response inhibition-related neurobiology has been theorized to underlie individual differences in DI, but little empirical work has been conducted. To test this hypothesis, baseline data from a large clinical sample with elevated risk for affective psychopathology was utilized (N = 254). Participants completed a complex Go/No-go task while EEG was recorded, and No-go N2/P3 amplitudes and latencies were measured. Based upon prior findings on the relations between these components and response inhibition, we hypothesized that DI would predict reduced No-go N2/P3 amplitude and greater No-go N2/P3 latency while controlling for current anxious/depressive symptom severity. Partially consistent with predictions, high DI was independently associated with reduced No-go N2 amplitude but was non-significantly related to latency, though high DI was linked with greater Go N2 latency. Contrary to predictions, no relations between DI and the P3 were found. Further, exploratory analyses revealed positive associations between DI and No-go P2 amplitude/latency. Correlations between components and task performance suggest that observed relations between DI and the P2/N2 may reflect inefficient rather than impaired response inhibition. Overall, results support the theorized relevance of response inhibition-linked neurobiology to individual differences in tolerance of distress over and above distress severity itself, and suggest specific relations between DI and alterations in early selective attention/conflict-monitoring but not evaluative phases of response inhibition.

Background Although the relationship between posttraumatic stress disorder (PTSD) and suicide has been firmly established, research on underlying mechanisms has been disproportionately low. The cognitive concerns subscale of anxiety sensitivity (AS), which reflects fears of cognitive dyscontrol, has been linked to both PTSD and suicide and thus may serve as an explanatory mechanism between these constructs. Methods The sample consisted of 60 male veterans presenting to an outpatient Veteran Affairs (VA) clinic for psychological services. Upon intake, veterans completed a diagnostic interview and brief battery of self-report questionnaires to assist with differential diagnosis and treatment planning. Results Results revealed a significant association between PTSD symptom severity and higher suicidality (i.e., ideation, plans, and impulses), even after accounting for relevant demographic and psychological constructs. Moreover, AS cognitive concerns mediated this association. Limitations Limitations include the small sample size and cross-sectional nature of the current study. Conclusions These findings add considerably to a growing body of literature examining underlying mechanisms that may help to explain the robust associations between PTSD and suicide. Considering the malleable nature of AS cognitive concerns, research is needed to determine the extent to which reductions in this cognitive risk factor are associated with reductions in suicide among at risk samples, such as those included in the present investigation.

Despite the high levels of comorbidity between post-traumatic stress disorder (PTSD) and sleep disturbance, little research has examined the predictors of insomnia and nightmares in this population. The current study tested both PTSD-specific (i.e. PTSD symptoms, comorbid anxiety and depression, nightmares and fear of sleep) and insomnia-specific (i.e. dysfunctional beliefs about sleep, insomnia-related safety behaviours and daily stressors) predictors of sleep quality, efficiency and nightmares in a sample of 30 individuals with PTSD. Participants participated in ecological momentary assessment to determine how daily changes in PTSD- and insomnia-related factors lead to changes in sleep. Multi-level modelling analyses indicated that, after accounting for baseline PTSD symptom severity, PTSD-specific factors were associated with insomnia symptoms, but insomnia-specific factors were not. Only daytime PTSD symptoms and fear of sleep predicted nightmares. Both sleep- and PTSD-related factors play a role in maintaining insomnia among those with PTSD, while nightmares seem to be linked more closely with only PTSD-related factors.

Intolerance of uncertainty (IU) is an important transdiagnostic variable within various anxiety and mood disorders. Theory suggests that individuals high in IU interpret ambiguous information in a more threatening manner. A parallel line of research has shown that interpretive biases can be modified through cognitive training and previous research aimed at modifying negative interpretations through Cognitive Bias Modification (CBM-I) has yielded promising results. Despite these findings, no research to date has examined the efficacy of an IU-focused CBM-I paradigm. The current study investigated the impact of a brief IU-focused CBM-I on reductions in IU. Participants selected for a high IU interpretation bias (IU-IB) were randomly assigned to an active (IU CBM-I) or control CBM-I condition. Results indicated that our active IU CBM-I was associated with significant changes in IU-IB from pre-to-post intervention as well as with significant reductions in IU at post-intervention and month-one follow-up. Findings also found that the IU CBM-I led to reductions in IU self-report via the hypothesized mechanism. This study is the first to provide evidence that a CBM-I focused on IU is effective in reducing IU-IB and IU across time and suggest that IU CBM-I paradigms may be a novel prevention/intervention treatment for anxiety.

Insomnia is a risk factor for Suicidal Ideation (SI) and Behavior (SB), yet the nature of the relations is unclear, including the potential mediating role of cognitive and affective/somatic symptoms of depression. It was hypothesized that the impact of insomnia on SI would be mediated through depressive symptoms and that insomnia would directly impact SB. Current and former military service members (N =405; M age =31.6 years, SD =7.3; 90.4% male, 76.5% White) who endorsed recent suicidal ideation and/or a history of suicide attempt completed measures of insomnia, depression, SI, and SB at baseline and at month 12 follow-up. Mediation models were conducted using structural equation modeling. Significant mediation from insomnia to baseline SI and month 12 SI was found through cognitive/affective depression. Insomnia was directly related to SB occurring between baseline and month 12 follow-up. These findings suggest that cognitive/affective depression mediates the association with SI but not SB. Results build on research showing the importance of depressive symptoms in SI in particular. The direct and indirect pathways from insomnia to SI/SB suggest that clinicians should be aware of these relations when treating patients reporting insomnia.

Intolerance of uncertainty (IU) is a multidimensional construct that has been proposed as an important transdiagnostic risk factor across various anxiety and mood disorders. Recent work found support for IU having a continuous latent structure when utilizing taxometric methods. However, taxometrics may not be ideally suited to examine the latent structure of constructs such as IU given the methodological shortcomings associated with this technique. The current study applied factor mixture modeling, a statistical technique that overcomes shortcomings of prior work, to examine the latent structure of IU in a sample of 371 individuals presenting at an outpatient clinic. Findings indicated that the best fitting solution was a 3-class model with 1 class consisting of individuals with high levels of IU (High IU; n = 55) and 1 containing individuals with low levels of IU (Low IU; n = 206). Our third class, labeled Moderate IU, consisted of 110 individuals with levels of IU between those of the High IU and Low IU groups. There were also significant differences across the 3 IU classes, including the relations between IU classes and anxiety-related and depressive disorders. The current investigation was the first to find evidence of IU having a categorical latent structure. Implications for research and clinical utility are discussed. (PsycINFO Database Record

Objective Anxiety sensitivity (AS; fear of anxiety) is a malleable risk factor for anxiety and depression. Brief computerized interventions, including elements of psychoeducation, interoceptive exposure, and cognitive bias modification (CBM) can reduce anxiety and depression through AS reductions. These interventions are not equally efficacious for all who receive them, suggesting the need to explore moderators. Attentional control (AC), the ability to regulate attentional processes by focusing and shifting attention as needed, has been linked to AS, anxiety, and depression suggesting that it may moderate treatment efficacy. The moderating effects of self-report and neurophysiological (i.e., theta/beta ratio, occipital alpha power) indices associated with AC processes on a brief AS-focused intervention were examined. Method Participants (M age = 36.43, SD = 16.47; 57.5% female) were randomized to cognitive AS treatment (n = 67) or a repeated contact control (n = 60). Results Occipital alpha power moderated the rate of change in AS across three weekly treatment sessions as well as the effects of the intervention on anxiety and depression symptoms at the 1-month follow-up. Lower alpha power was associated with a swifter reduction in AS symptoms and marginally lower levels of anxiety and depression at follow-up. AC indices were not correlated with each other. Conclusions These findings present a novel hypothesis that lower AC as indexed by occipital alpha power might increase treatment gains in the context of a brief transdiagnostic treatment for anxiety and depression. These findings also highlight the need for external validity studies of AC indices. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

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.

The opioid epidemic is having a disproportionate impact on veterans. Indeed, veterans are twice as likely to die from an accidental overdose than members of the general population, even after accounting for gender and age distribution. Although many veterans seek treatment, a large proportion drop out prematurely and/or relapse highlighting the need to identify malleable factors that may contribute to the recovery process. One such variable is anxiety sensitivity (AS; i.e., fear of anxious arousal). AS is elevated in opioid use populations and is a predictor of treatment dropout among opioid users. Importantly, research suggests that AS is highly malleable; although, no studies have systematically examined such protocols among opioid users. To this end, the purpose of the proposed study was to test the acceptability, feasibility, and utility of a brief, one-session Computerized Anxiety Sensitivity Treatment (termed CAST) delivered to veterans seeking services for an opioid use disorder (OUD). Veterans (n = 16) were assessed at baseline and also at one-week and one-month following CAST. All veterans completed the protocol and reported being interested and engaged during the intervention. Further, small to medium reductions in psychopathology and substance use outcomes were found. Although more work is needed, the current study provides preliminary support for the effectiveness of a brief AS-focused intervention among veterans seeking treatment for an OUD.

This randomized controlled trial (RCT) compared the efficacy of Transdiagnostic Behavior Therapy (TBT) to Behavioral Activation Treatment for Depression (BATD) in veterans diagnosed with affective disorders. TBT is a transdiagnostic psychotherapy designed to address depressive, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Preliminary findings have been promising; however, no RCT has been completed to date. 105 treatment-seeking veterans were recruited and completed diagnostic and self-report measures, and then randomized into TBT or BATD treatment conditions for 12 weekly psychotherapy sessions. Assessment measures were re-administered at immediate post-treatment and 6-month follow-up. Of the 93 participants initiating treatment, 50 participants completed the full treatment protocol (TBT n = 29; BATD n = 21). No differences were observed in treatment completion across groups. Participants demonstrated significant treatment improvements across all assessments, including measures of depression, anxiety (general, cognitive, and somatic), stress, PTSD symptoms, and transdiagnostic impairment. Group differences with small effect sizes were observed in most of the studied measures, favoring TBT compared to BATD. Together, the findings support the growing literature on the efficacy of transdiagnostic psychotherapies, compared to disorder-specific treatments (DSTs). Related to the outcome findings, the benefits for transdiagnostic protocols in terms of symptom coverage, dissemination, and access were discussed.

Objective Anxiety disorders contribute substantially to the overall public health burden. Anxiety sensitivity (AS), a fear of anxiety-related sensations, is one of the few known malleable risk factors for anxiety pathology. Previous AS reduction treatments have primarily utilized “top-down” (e.g., psychoeducation) interventions. The goal of the current study was to evaluate the effect of adding a “bottom-up” (interpretation bias modification; CBM-I) intervention to an AS psychoeducation intervention. Design Single-site randomized controlled trial. Participants completed either a 1) Psychoeducation + active CBM-I or 2) Psychoeducation + control CBM-I intervention. Change in AS was assessed post-intervention and at a one-month follow-up. Participants Individuals with elevated levels of AS. Intervention Single-session computer-delivered intervention for AS. Results Accounting for baseline ASI-3 scores, post-intervention ASI-3 scores were significantly lower in the combined condition than in the psychoeducation + control CBM-I condition (β = 0.24, p d = 0.99). The active CBM-I plus psychoeducation AS intervention was successful in reducing overall AS (59% post-intervention; p d = 0.99) and these reductions were maintained through one-month post-intervention (52%; p d = 1.18). Participants in the active condition reported significantly lower rates of panic responding to a vital-capacity CO 2 challenge (OR = 6.34, 95% CI = 1.07–37.66). Lastly, change in interpretation bias significantly mediated the relationship between treatment condition and post-treatment AS reductions. Conclusions The current intervention was efficacious in terms of immediate and one-month AS reductions. Given its brevity, low-cost, low-stigma and portability, this intervention could lead to reducing the burden of anxiety disorders.

Objective Anxiety sensitivity (AS) is a well-established transdiagnostic risk factor for anxiety and mood psychopathology including suicide. A variety of interventions using cognitive-behavioral skills as well as cognitive bias modification (CBM) suggest that AS can be quickly and effectively reduced in nonclinical and nontreatment seeking samples. However, it is unclear whether AS reduction protocols will have efficacy for more severe clinical samples. Moreover, the combination of cognitive-behavioral techniques with CBM focused on changing interpretation bias (CBM-I) related to AS has not been evaluated. Method A patient sample with co-occurring anxiety psychopathology and active suicidal ideation (N = 74) was randomly assigned to a brief 1-session computerized treatment including: (a) psychoeducation and interoceptive exposure (i.e., cognitive anxiety sensitivity treatment [CAST]) plus CBM-I for AS; or (b) health information condition plus sham CBM for AS. Participants were assessed immediately after the 1-hr intervention as well as at 1- and 4-month follow-ups. Results Consistent with hypotheses, participants in the active treatment showed significantly greater AS reduction that was maintained through follow-up (effect sizes ranged from medium to large for the overall AS and the AS subscales). Mediation analyses suggested that changes in AS mediated suicide outcomes. Conclusions In sum, these are the first findings to suggest that brief AS reduction protocols have efficacy both in terms of risk and symptom outcomes in patient samples showing active suicidal ideation. (PsycINFO Database Record

Despite clear indications that hoarding behaviors contribute to social isolation and strained family relationships, no research to date has examined the associations between hoarding and several important interpersonal constructs (i.e., perceived burdensomeness and thwarted belongingness). Moreover, no research has examined how these various interpersonal needs may account for the associations between symptoms of hoarding and depression. Community participants (N = 125) with elevated hoarding symptoms were assessed on the interpersonal constructs of interest. Hoarding severity was significantly associated with perceived burdensomeness even after controlling for overall levels of negative affect. Moreover, perceived burdensomeness significantly mediated the relationship between hoarding severity and depressive symptoms. To our knowledge this is the first study to examine potential mechanisms that may account for the robust associations between hoarding and depression. Future investigations should attempt to replicate these findings using clinical samples.

Objectives Exposure-based psychotherapies for posttraumatic stress disorder (PTSD) are effective for many, but not all patients. It is important to determine for whom these treatments work and to examine predictors of success. Method An 8-week modified prolonged exposure (PE) treatment, including components of behavioral activation and reducing the number of imaginal exposure sessions, was administered to a sample of 231 Veterans (mean age = 45.7 years, standard deviation = 14.89). Growth mixture modeling was used to model PTSD symptom trajectories across the 8-week intervention and a postintervention appointment. Further, baseline demographics, social support, clinician-rated PTSD symptoms, anxiety, and depression were examined as predictors of trajectories. Results Three classes emerged, labeled responders (n = 35), nonresponders (n = 190), and immediate responders (n = 6). The only significant baseline difference between responders and nonresponders was higher anxiety symptoms in the nonresponders. At follow-up time points, there were higher levels of clinician-rated PTSD, anxiety, and depression symptoms and lower social support in the nonresponders compared to the responders. Conclusion Findings suggest that modifying standard PE treatments by reducing imaginal exposure sessions while adding behavioral activation may not be advisable for most Veterans with PTSD.

Distress intolerance is a key vulnerability factor implicated in the maintenance and relapse of cigarette smoking. Yet, past work has not examined changes in these processes during smoking cessation treatment or their relation to smoking cessation outcomes. The aim of the present study was to examine the effect of two smoking cessation interventions on changes in self-report and behavioral distress intolerance indices during treatment, and whether these changes are associated with smoking cessation outcomes. Treatment-seeking smokers (N = 384) were randomly assigned to one of two 4-session smoking cessation treatment programs: Standard Cessation Program (SCP) or Smoking Treatment and Anxiety Management Program (STAMP). Quit dates were scheduled to coincide with the final treatment session. Physical domains of distress intolerance were assessed at baseline and at each weekly session, via the Discomfort Intolerance Scale (DIS; higher scores indicate more intolerance for discomfort) and Breath Holding Duration Task (shorter durations indicate more intolerance for respiratory distress). The STAMP condition produced a greater rate of reduction in DIS scores than did the SCP condition. Changes in DIS scores during treatment mediated the effect of STAMP treatment on 7-day point prevalence abstinence at Month 3 post-quit attempt. There were no treatment conditions differences in changes in Breath-Holding duration. Data suggest self-reported distress intolerance is malleable in the context of stress sensitivity reduction treatment, but not standard smoking cessation treatment, and such reductions may result in promotion of smoking abstinence.

The interpersonal-psychological theory of suicide posits that perceived burdensomeness (PB; i.e., the belief that others would be better off if one were dead) and thwarted belongingness (TB; i.e., the belief that one lacks meaningful social connections) are both necessary risk factors for the development of suicidal ideation. To test these relations, measures are needed that are well validated, especially in samples of at-risk adults.The current study was designed to examine the factor structure of an eight-item version of the Interpersonal Needs Questionnaire (INQ) in a sample of 405 U.S. past and current military personnel (MA bifactor model comprising a general factor, labeled interpersonal needs, and two specific factors, labeled PB and TB, fit the data best. The general factor captured a high proportion of overall variance (81.9%). In contrast, the TB factor captured only a modest amount of variance in items meant to capture this factor (59.1%) and the PB factor captured very little variance in items meant to capture this factor (13.5%). Further, only the interpersonal needs factor was associated with lifetime and past-week suicidal ideation as well as suicidal ideation frequency and duration.The current findings indicate that, for the INQ-8 in high-risk military personnel, a general interpersonal needs factor accounted for the relations PB and TB share with suicidal ideation.

Suicide constitutes a significant public health burden as global suicide rates continue to increase. Thus, it is crucial to identify malleable suicide risk factors to develop prevention protocols. Anxiety sensitivity, or a fear of anxiety-related sensations, is a potential malleable risk factor for the development of suicidal ideation. The Depression-Distress Amplification Model (DDAM) posits that the anxiety sensitivity cognitive concerns (ASCC) subfactor interacts with depressive symptoms to amplify the effects of depression and lead to suicidal ideation. The current study tested the DDAM across the two most widely-replicated factors of depressive symptoms (cognitive and affective/somatic) in comparison to a risk factor mediation model where ASCC are related to suicidal ideation via depressive symptoms. Participants included 295 clinical outpatients from a community clinic. The interaction between ASCC and depressive symptoms in the prediction of suicidal ideation was not significant for either cognitive or affective/somatic symptoms of depression. However, results revealed a significant indirect effect of ASCC through cognitive symptoms of depression in the prediction of suicidal ideation. These cross sectional findings are not consistent with the DDAM. Rather, the relationship may be better conceptualized with a model in which ASCC is related to suicidal ideation via cognitive symptoms of depression.

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.

Depression is often modeled as a unidimensional construct despite evidence for distinct symptom dimensions (i.e., cognitive, affective, and somatic symptoms). Intolerance of uncertainty (IU; a cognitive bias that increases distress in uncertain situations) is a risk factor implicated in the development of depression. However, it is unclear how IU lower-order dimensions (i.e., inhibitory IU, the fear of future unpredictable events; prospective IU, avoidance due to fear of uncertain events) relate to depressive symptoms. The current study used confirmatory factor analysis and structural equation modeling to examine the relations between depressive symptoms and lower-order dimensions of IU in a sample of 374 adults (M age = 35.5, 54.3% female) with elevated psychopathology (89.2% meeting criteria for at least one DSM-5 diagnosis, 25.6% primary depressive disorder). A two-factor model of depression, composed of Cognitive and Affective/Somatic factors, provided superior model fit compared to one- and three-factor solutions. A bifactor model of IU, composed of a general IU factor and specific Inhibitory IU and Prospective IU factors, provided superior model fit compared to one- and two-factor solutions. The general IU factor related to both Cognitive and Affective/Somatic factors. Inhibitory IU related to the Cognitive factor, but not the Affective/Somatic factor. Prospective IU was not related to Cognitive or Affective/Somatic factors. These findings elucidate the relations between IU and depression symptoms and have important theoretical implications regarding the etiology of depressive symptoms. In particular, inhibitory IU may be a novel target for intervention efforts in individuals presenting with depressive symptoms.

Intimate-partner violence (IPV) in adolescent and young-adult dating relationships is a prevalent and serious public health problem. The measurement of IPV across adolescence has most commonly relied on the Conflict in Adolescent Dating Relationship Inventory (CADRI; Wolfe et al., 2001), which postulates 5 distinct yet related types of IPV (i.e., threatening, verbal/emotional, relational, physical, and sexual). However, the CADRI has received minimal examination to confirm its factor structure, in particular, whether the factor structure is invariant across sex, race/ethnicity, and time, despite the clinical use of this measure for screening and treatment purposes. In response, we conducted a confirmatory factor analysis of the CADRI and tested whether the factor structure was invariant across sex, race/ethnicity, and time. Adolescents (N = 1,042, 56% girls, mean age at baseline = 15.09, SD = 0.79) from high schools in the southwestern United States completed the CADRI annually for 6 consecutive years. Results confirmed the 5-factor structure of the CADRI and demonstrated measurement invariance across sex, race/ethnicity, and time. Our findings suggest that the CADRI captures 5 related but distinct types of IPV and that use of the CADRI is appropriate across sex, race/ethnicity, and time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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.

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...

Psychogenic movement disorders (PMDs) are common, associated with significant psychosocial impairments, and frequently comorbid with other physical and psychiatric conditions. However, treatment of PMDs has been largely unsuccessful. Recently, treatments focused on conditions comorbid with PMDs have been hypothesized as a possible improvement to PMD-focused treatments. This case report describes a patient initially diagnosed with a PMD and referred for psychotherapy after appointments with neurologic and psychiatric providers. Upon referral to psychotherapy, the patient received a diagnosis of comorbid obsessive-compulsive disorder (OCD) and treatment with exposure and response prevention (ERP), an evidence-based psychotherapy for OCD. The patient demonstrated reliable improvements in all self-report measures as well as remission of PMD and OCD symptoms via behavioral observation at the end of therapy and at a 1-month follow-up. This case presents initial support for the treatment of comorbid and overlapping conditions in patients with PMDs, providing a pilot demonstration to support future large investigations.

Depression is typically treated as a homogeneous construct despite evidence for distinct cognitive, affective, and somatic symptom dimensions. Anxiety sensitivity (AS; the fear of consequences of anxiety symptoms) is a cognitive risk factor implicated in the development of depressive symptoms. However, it is unclear how lower order AS dimensions (i.e. physical, cognitive, and social concerns) relate to depressive symptom factors. Confirmatory factor analysis, followed by structural equation modeling, were conducted to examine the factor structure of depression and to then examine the relations between these factors and the lower order factors of AS. This study was conducted in a sample of 374 adults (M age = 35.5, 54.3% female) with elevated levels of psychopathology (89.2% meeting criteria for at least one DSM-5 diagnosis, 25.6% primary depressive disorder). In this study a two-factor model of depression, composed of Cognitive and Affective/Somatic factors, was superior to one- and three-factor solutions. AS cognitive concerns were related to both cognitive and affective/somatic symptoms of depression. Neither of the other AS dimensions was related to depression symptom dimensions. These findings provide a better understanding of the relations between AS and depression symptoms.

Worry, the anticipation of future threat, is a common feature of anxiety and mood psychopathology. Considerable research has examined the latent structure of worry to determine whether this construct reflects a dimensional or taxonic structure. Recent taxometric investigations have provided support for a unidimensional structure of worry; however, the results of these studies are limited in that taxometric approaches are unable to assess for the presence of more than two classes of a given construct. Given the complex nature of worry, it is possible that worry may actually reflect a latent structure comprised of multiple classes that cannot be assessed through taxometric approaches. Thus, it is important to utilize newer statistical techniques, such as factor-mixture modeling (FMM), which allow for a more nuanced assessment of the latent structure of a given psychological construct. The aim of the current study was to examine the latent structure of worry using FMM. It was predicted that worry would reflect a three-class structure comprised of (1) a class of low, normative levels of worry, (2) a class of moderate, subclinical worry, and (3) a class of high, pervasive worry. The latent class structure of worry was assessed using FMM in a sample of 1337 participants recruited from the community through a research clinic. Results revealed a three-class structure of the PSWQ comprising low, moderate-high, and high classes of worry. We also provided convergent and discriminant validity of the worry classes by demonstrating that the high worry class was most associated with GAD and that the low worry class was the least associated with GAD. The clinical utility of the worry classes, including the creation of empirically based cut-scores, and the implications for future research are discussed.

Anxiety sensitivity (AS), or fear of anxious arousal, is a higher-order cognitive risk-factor for posttraumatic stress disorder (PTSD) composed of lower-order physical, cognitive, and social concerns regarding anxiety symptoms. Brief and effective interventions have been developed targeting AS and its constituent components. However, there is limited evidence as to whether an intervention aimed at targeting AS would result in reductions in PTS symptoms and whether the effects on PTS symptoms would be mediated by reductions in AS. Furthermore, there is no evidence whether these mediation effects would be because of the global or more specific components of AS. The direct and indirect effects of an AS intervention on PTS symptoms were examined in a sample of 82 trauma-exposed individuals (M age = 18.84 years, SD = 1.50) selected based on elevated AS levels (i.e., 1 SD above the mean) and assigned to either a treatment (n = 40) or an active control (n = 42) condition. Results indicated that the intervention led to reductions in Month 1 PTS symptoms, controlling for baseline PTS symptoms. Furthermore, this effect was mediated by changes in global AS and AS social concerns, occurring from intervention to Week 1. These findings provide an initial support for an AS intervention in amelioration of PTS symptoms and demonstrate that it is primarily reductions in the higher-order component of AS contributing to PTS symptom reduction.

Background Whereas prior work has established fear and distress clusters underlying unipolar mood and anxiety disorders, the optimal placement of obsessive–compulsive disorder (OCD) within this model is unclear. One likely contributor to this ambiguity is the heterogeneous nature of OCD. There is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. Using structural equation modeling, the current study examined the relations between various OCD symptom dimensions and symptoms associated with fear/distress disorders. Methods Participants included 526 individuals recruited from an online crowdsourcing marketplace. Results Results revealed that the symmetry obsessions/arranging compulsions, harm obsessions/checking compulsions, and unacceptable thoughts/neutralizing compulsions were related to both fear and distress disorder symptoms, whereas the contamination obsessions/washing compulsions dimension of OCD was specifically related to fear disorder symptoms. Limitations Limitations include the use of self-report questionnaires to measure all constructs of interest. Conclusions These findings add to a growing body of literature attesting to the multidimensional nature of OCD and progress our understanding of the etiological underpinnings of this severe and debilitating condition.

The Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007) is a self-report assessment of anxiety sensitivity, reflecting an individual's tendency to misinterpret the meaning of anxiety-relevant sensations. Despite this construct being related to a wide array of clinically significant smoking maintenance and relapse processes, the psychometric properties of scores on the ASI-3 have not yet been investigated for use among smokers. Therefore, the current study aimed to test the psychometric properties of the scores on the ASI-3 in a sample of cigarette smokers. Participants were treatment-seeking daily smokers who completed the ASI-3 at a precessation visit (Time 1, N = 464) and 3 months postcessation attempt (Time 2, n = 137). Confirmatory factor analyses results of the scores on ASI-3 at Time 1 and Time 2 revealed the hypothesized 3-factor model, including physical, social, and cognitive concerns. In addition, the ASI-3 factor scores evidenced factor stability, test-retest reliability, internal consistency, and convergent, and discriminant, and predictive validity. The present study provides evidence in support of the validity and reliability of scores on the ASI-3 as a measure of anxiety sensitivity among treatment-seeking cigarette smokers.

Existing research on the relationship between obsessive-compulsive disorder (OCD) and insomnia is scarce. Moreover, no research has examined potential mechanisms that may account for the observed relations among OCD and sleep difficulties. The cognitive concerns subscale of anxiety sensitivity (AS), which reflects fears of mental incapacitation, has been linked to both symptoms of OCD and insomnia and may serve as a mechanism for increasing sleep disturbance among patients with OCD. The current study examined the relationship between OCD symptoms and insomnia and the potential mediating role of AS cognitive concerns. The sample consisted of 526 individuals recruited through Amazon's Mechanical Turk (Mturk), an online crowdsourcing marketplace. Results revealed distinct associations between the unacceptable thoughts domain of OCD and symptoms of insomnia. Additionally, AS cognitive concerns mediated the relationship between these constructs. Future research should seek to replicate these findings using clinical samples and prospective designs.

Anxiety sensitivity (AS), the belief that anxious arousal is harmful, is a malleable risk factor that has been implicated in anxiety and depression symptoms in adolescents. Although there is some evidence that adolescents possess distinct developmental trajectories, few studies have explored this topic. This study examined the developmental trajectory of AS in 248 adolescents (M age = 11.0 years, SD = 0.82; 56% male) across 6 years, beginning when children were age 11. This study also examined the influence of AS trajectories on anxiety and depression at age 16. Finally, this study examined the utility of AS classes in identifying anxiety and depression growth. Three AS classes were found, described by normative-stable, high-stable, and high-unstable trajectories. Adolescents in the high-stable and the high-unstable AS classes had higher levels of anxiety and depression at age 16 than did adolescents in the normative-stable AS class. In addition, the anxiety and depression trajectories fit by AS class mirrored the AS class trajectories. These findings suggest three AS trajectories can be identified in adolescents. These trajectories are discussed in relation to a developmental perspective of AS.

It is unclear what factor structure best represents the Positive and Negative Affect Schedule (PANAS) from childhood to adulthood. The PANAS structure was examined in a sample of 555 children (M age = 11.66, SD = 1.24), 608 adolescents (M age = 15.45, SD = 1.09), and 553 young adults (M age = 18.75, SD = 1.00). A partially invariant model consisting of Positive Affect, Fear, and Distress factors best represented the PANAS across all age groups, indicating that the underlying constructs are the same across age but that the factors become increasingly interrelated with increasing age.