Adrienne L. Johnson

Evaluating the role of anxiety sensitivity in barriers to cessation and reasons for quitting among smokers with asthma

The aim of the present study was to examine the unique predictive ability of anxiety sensitivity (AS) in terms of perceived barriers to cessation and smoking cessation motives among daily smokers with asthma (n = 125, 54% male, Mage = 37.7 years, SD = 12.1). As hypothesized, after controlling for the effects of race, asthma control, negative affect, and smoking rate, AS significantly predicted greater barriers to cessation, and reasons for quitting related to health concerns and self-control. Contrary to hypotheses, AS did not significantly predict external reasons for quitting. These findings suggest that smokers with asthma who are fearful of physiological arousal may be a particularly ‘at-risk’ population for smoking cessation difficulties due, in part, to greater perceived barriers to cessation. Interventions focused on enhancing intrinsic motivation for quitting and reducing AS may be most effective for this population.

Associations between mindfulness and panic symptoms among young adults with asthma

Despite the well-documented associations between panic psychopathology and asthma, there has been a dearth of empirical work examining factors that may reduce the negative effects of panic for individuals with asthma. Thus, the goal of the present study was to examine the role of mindfulness skills (i.e. observe, describe, acting with awareness, nonjudgment, and nonreactivity) in symptoms of panic psychopathology (i.e. panic symptoms, anxiety sensitivity, and body vigilance). Participants were young adults with asthma (n = 56; 30.4% male, Mage = 19.5 years, SD = 2.7) who completed online self-report measures for course credit. After controlling for the effects of asthma control and negative affectivity, greater use of the mindfulness skill of acting with awareness, relative to the other mindfulness skills, significantly predicted fewer panic symptoms and decreased anxiety sensitivity. The skill of observing approached statistical significance in terms of predicting increased body vigilance and anxiety sensitivity. These finding suggest that targeting the skill of acting with awareness may be a novel way to decrease panic symptomatology among individuals with asthma.

Evaluation of smokers with and without asthma in terms of smoking cessation outcome, nicotine withdrawal symptoms, and craving: Findings from a self-guided quit attempt.

INTRODUCTION The aim of the current study was to evaluate smoking cessation outcome, nicotine withdrawal symptoms, and craving between smokers with (n=47; 46.8% male, Mage=40.0years, SD=11.7) and without (n=45; 51.1% male, Mage=37.5years, SD=11.1) asthma during a self-guided quit attempt. METHODS After completing a baseline assessment visit, participants attended study sessions on their scheduled quit day as well as follow-up visits (3days, 7days, 14days, and 28days) after their quit day. RESULTS Smokers with and without asthma did not differ in abstinence rates, smoking lapse, and rate of change in urge to smoke to reduce negative affect. However, smokers with asthma demonstrated a slower rate of decline in nicotine withdrawal symptoms and craving over time. CONCLUSIONS These findings suggest that smokers with asthma may benefit from specialized smoking cessation treatments to address prolonged withdrawal symptoms and craving.

The indirect effect of emotion dysregulation in terms of negative affect and smoking-related cognitive processes.

INTRODUCTION Although negative affect is associated with a number of smoking-related cognitive processes, the mechanisms underlying these associations have yet to be examined. The current study sought to examine the indirect effect of emotion regulation difficulties in terms of the association between negative affect and smoking-related cognitive processes (internal barriers to cessation, negative affect reduction smoking motives, negative affect reduction smoking outcome expectancies). METHOD Participants were 126 daily cigarette smokers (70.4% male, Mage=36.5years, SD=13.0; 69.8% Caucasian) who smoked an average of 18.5 (SD=8.7) cigarettes per day and reported moderate nicotine dependence. RESULTS Formal mediation analyses were conducted using PROCESS to examine the indirect effect of negative affect on internal barriers to cessation and negative affect reduction smoking motives and outcome expectancies through emotion regulation difficulties. After accounting for the effects of gender, daily smoking rate, and anxiety sensitivity, negative affect was indirectly related to internal barriers to cessation and negative affect reduction smoking motives through emotion regulation difficulties. There was no significant indirect effect for negative affect reduction smoking outcome expectancies. CONCLUSIONS These findings suggest that greater negative affect is associated with a desire to smoke to reduce this negative affect and perceptions that quitting smoking will be difficult due to negative emotions because of greater difficulties managing these negative emotions. Thus, emotion regulation difficulties may be an important target for smoking cessation interventions.

Differences in panic psychopathology between smokers with and without asthma

Abstract Cigarette smoking is more common among individuals with asthma compared to those without, resulting in increased risk of morbidity and mortality. However, there has been little exploration of psychological factors that differ between smokers with and without asthma. Thus, the aim of the current study was to examine differences between smokers with and without asthma in terms of anxiety sensitivity, panic symptoms, lifetime history of panic attacks, and lifetime history of panic disorder. Participants were 115 smokers with asthma (55.3% male, Mage = 38.4 years, SD = 11.9) and 120 smokers without asthma (70.6% male, Mage = 37.0 years, SD = 12.8) who were administered a structured diagnostic interview and completed self-report measures. As hypothesized, after controlling for the effects of cigarettes per day, gender, race, and education, smokers with asthma reported higher levels of anxiety sensitivity and panic symptoms and were at an increased risk for having a lifetime history of panic attacks (OR = 3.01) and panic disorder (OR = 2.96) compared to smokers without asthma. Further, group differences in anxiety sensitivity and panic symptoms remained even after removing participants with a lifetime history of panic attacks or panic disorder. These findings suggest that smokers with asthma are a particularly ‘at-risk’ population for panic psychopathology and likely in need of specialized smoking-related prevention and intervention efforts.

An Examination of the Indirect Effect of Anxiety Sensitivity in terms of Asthma and Smoking Cessation Processes.

INTRODUCTION Despite the increased rates of smoking and poor cessation outcomes among individuals with asthma relative to those without, little scholarly attention has examined mechanisms linking asthma to smoking cessation processes. The current study sought to examine the indirect effect of anxiety sensitivity in terms of asthma and smoking cessation processes (i.e., duration of longest quit attempt, motivation to quit smoking, smoking dependence motives). METHODS Participants were 90 regular daily smokers: 43 with asthma (51.2% male, M(age) = 38.0 years, SD = 12.5) and 47 without asthma (46.8% male, M(age) = 35.4 years, SD = 11.2) who were participating in a larger smoking cessation study. Data from the baseline (pre-quit attempt) assessment session were used. RESULTS After accounting for the effects of gender, race, daily smoking rate, and negative affectivity, asthma status was indirectly related to motives for smoking related to nicotine dependence and motivation to quit smoking through anxiety sensitivity. There was no significant indirect effect for duration of longest quit attempt. CONCLUSIONS These findings suggest that smokers with asthma may be particularly fearful of physiological arousal, which in turn, may account for greater motivation to quit smoking, but also stronger dependence motives for smoking.

Panic and epilepsy in adults: A systematic review.

The purpose of the current paper was to review the empirical literature on the cooccurrence of panic and epilepsy, in order to determine whether there is an increased risk of panic attacks and panic disorder among adults with epilepsy and an increased risk of epilepsy among adults with panic disorder. Given the overlap between panic and ictal fear, a preliminary aim of the current review was to critically evaluate the methodology used to differentiate between diagnoses of panic disorder and epilepsy in existing research. A literature search was conducted in relevant electronic databases, and articles that directly focused on panic and epilepsy among adults were selected for the current review (n = 17). Overall, results suggest that rates of epilepsy are elevated among individuals with panic disorder and that panic attacks are elevated among individuals with epilepsy, but rates of panic disorder among people with epilepsy are inconsistent. However, most studies did not use sufficiently rigorous methods to differentiate between panic disorder and epilepsy. Therefore, a critical next step in this area of research is to develop a standard procedure for differentiating ictal fear from panic attacks and panic disorder.

The role of anxiety sensitivity-physical concerns in terms of quit day withdrawal symptoms and cravings: A pilot test among smokers with asthma

ABSTRACT Objective: The aim of the current study was to conduct secondary analyses of data collected from a study examining a self-guided quit attempt of smokers with and without asthma in order to examine the unique predictive ability of precessation (i.e., baseline) anxiety sensitivity physical concerns in terms of quit day withdrawal symptoms and cravings among abstinent smokers with asthma. Methods: Participants were 24 regular cigarette smokers with asthma (50% female, Mage = 37.63 years, SD = 12.20) who participated in a self-guided-quit attempt and were able to maintain abstinence on their quit day. Results: After controlling for the effects of the cognitive and social concerns domains of anxiety sensitivity, anxiety sensitivity-physical concerns significantly predicted greater quit day withdrawal symptoms (20.8% unique variance) and urges to smoke (38.0% unique variance). Conclusions: These findings suggest that smokers with asthma who fear anxiety-related sensations due to their feared physical consequences are more likely to experience intense withdrawal symptoms and desire to smoke at the beginning of a quit attempt. Clinically, smokers with higher levels of anxiety sensitivity physical concerns may benefit from smoking cessation interventions that specifically target anxiety sensitivity as well as prolonged use of nicotine replacement therapies to target withdrawal symptoms and cravings.

Anxiety Sensitivity as a Predictor of Epilepsy-Related Quality of Life and Illness Severity Among Adult Epilepsy

The purpose of the current study was to examine the role of anxiety sensitivity in predicting seizure likelihood and QOL among 49 people with epilepsy (PWE; 63.3% female; Mage = 48.53, SD = 15.91). As hypothesized, after controlling for the effects of negative affectivity and past year seizure presence, greater levels of anxiety sensitivity significantly predicted poorer overall QOL as well as the QOL domains of seizure worry, medication effects, work-driving-social limitations, and cognitive functioning (8.8–22.9% unique variance). Anxiety sensitivity did not significantly predict seizure likelihood or QOL related to emotional well-being and energy difficulties. These findings suggest that PWE who are fearful of arousal-related sensations experience greater functional impairment, but not necessarily more severe epilepsy. Interventions aimed at decreasing anxiety sensitivity may be useful in improving QOL in this population.

Feasibility and Effectiveness of an Integrated Cognitive Behavioral Treatment to Address Psychological Distress in a Stroke Self-Management Program

This is a case-study of a Hispanic man who had an ischemic stroke and was participating in a stroke self-management (SSM) program. He was identified as having comorbid symptoms of anxiety and depression that were not addressed by the SSM program and was subsequently enrolled in the Enhance Psychological Coping after Stroke (EPiC) program. EPiC is a telephone-based cognitive-behavioral treatment integrating mental and stroke-related behavioral health principles that is delivered concurrent to the SSM program. Over the course of six sessions, the participant learned psychological symptom and behavioral monitoring, thought stopping, cognitive restructuring, deep breathing, calming thoughts, social support, and problem-solving skills aimed at overcoming barriers to engagement in behaviors taught in the SSM program. Client-centered psychological distress and behavioral health treatment goals were integrated into each session. The client demonstrated reduced anxiety symptoms and improved stroke SSM behaviors at 6, 12, and 18 weeks after the initiation of treatment. He also improved in disability, social role limitations, quality of life, and stroke self-efficacy at 18 weeks following the initiation of treatment. This case study demonstrates that incorporating an integrated cognitive behavioral treatment to an SSM program can be beneficial for decreasing psychological symptom barriers to SSM, which may reduce the risk of stroke recurrence.