Bridget A. Hearon

Cognitive Behavioral Therapy for Substance Use Disorders

Cognitive behavioral therapy (CBT) for substance use disorders has shown efficacy as a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts. Although CBT for substance abuse is characterized by heterogeneous treatment elements such as operant learning strategies, cognitive and motivational elements, and skills-building interventions, across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances. These elements, and support for their efficacy, are discussed.

Shared Variance Among Self-Report and Behavioral Measures of Distress Intolerance

Distress intolerance may be an important individual difference variable in understanding maladaptive coping responses across diagnostic categories. However, the measurement of distress intolerance remains inconsistent across studies and little evidence for convergent validity among existing measures is available. This study evaluated the overlap among self-report and behavioral measures of distress intolerance in four samples, including an unselected sample, a sample of patients with drug dependence, and two samples of cigarette smokers. Results suggested that the self-report measures were highly correlated, as were the behavioral measures; however, behavioral and self-report measures did not exhibit significant associations with each other. There was some evidence of domain specificity, with anxiety sensitivity demonstrating strong associations with somatic distress intolerance, and a lack of association between behavioral measures that elicit affective distress and those that elicit somatic distress. These findings highlight a potential divergence in the literature relative to the conceptualization of distress intolerance as either sensitivity to distress or as the inability to persist at a task when distressed. Further research is needed to elucidate the conceptualization and measurement of distress intolerance to facilitate future clinical and research applications of this construct.

Psychosocial predictors of sleep dysfunction: the role of anxiety sensitivity, dysfunctional beliefs, and neuroticism.

The present study examined the relationship of anxiety sensitivity, dysfunctional beliefs about sleep and neuroticism on sleep disturbance. Previous research of these three related concepts—each describing a different kind of reactivity to interoceptive or environmental events—have served as predictors of insomnia and insomnia-related distress; however, it is not known how these concepts have distinctive prediction of sleep outcomes. We completed an Internet survey of 149 undergraduate student participants, a population with elevated risk for disturbed sleep. Participants completed a demographics questionnaire, the Anxiety Sensitivity Index (ASI), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the NEO Five-Factor Inventory, and the Pittsburgh Sleep Quality Index (PSQI). Results revealed a significant association between PSQI total score and the three variables of interest, ASI, DBAS, and neuroticism. However, in a stepwise regression, neuroticism was the statistically most important predictor of sleep disturbance. The DBAS was a statistically more important predictor than ASI total score; however, when the ASI was examined by subscale, DBAS was replaced in the model by the ASI Mental Incapacitation Concerns subscale. Our findings highlight the continued value of higher order concepts like neuroticism in the development of disorder-specific measures like the DBAS, as well as indicate that distress in response to cognitive symptoms (AS-mental incapacitation) may play a role in maintaining sleep dysfunction.

Predictors of Dropout from Psychosocial Treatment in Opioid-Dependent Outpatients

BACKGROUND AND OBJECTIVES Early dropout is common in substance abuse treatment settings and may lead to poorer outcomes relative to those completing a full course of treatment. Attempts to identify predictors of dropout have yielded mixed results, highlighting the need for additional research in this area to clarify risk and protective factors to guide intervention and retention efforts. This study evaluated predictors of dropout from psychosocial treatment among opioid-dependent patients on methadone maintenance therapy. METHODS Participants included 78 patients who had failed to respond to at least 4 months of methadone maintenance plus group counseling with clinic substance abuse counselors, and were enrolled in a study of randomized psychosocial treatment in addition to treatment-as-usual. Several factors that have been implicated in previous studies as well as two affective variables (distress intolerance and coping motives for drug use) were examined. RESULTS Results indicated that when controlling for various risk factors, age was the only significant predictor of dropout, with younger patients more likely to discontinue treatment early. CONCLUSIONS This study replicates previous findings in opioid-dependent samples that younger patients are at an increased risk of early treatment dropout. CONCLUSIONS AND SIGNIFICANCE Targeted intervention may be needed to retain young patients in drug abuse treatment.

Psychosocial predictors of the onset of anxiety disorders in women: Results from a prospective 3-year longitudinal study

In a prospective, longitudinal, population-based study of 643 women participating in the Harvard Study of Moods and Cycles we examined whether psychosocial variables predicted a new or recurrent onset of an anxiety disorder. Presence of anxiety disorders was assessed every 6 months over 3 years via structured clinical interviews. Among individuals who had a new episode of anxiety, we confirmed previous findings that history of anxiety, increased anxiety sensitivity (the fear of anxiety related sensations), and increased neuroticism were significant predictors. We also found trend level support for assertiveness as a predictor of anxiety onset. However, of these variables, only history of anxiety and anxiety sensitivity provided unique prediction. We did not find evidence for negative life events as a predictor of onset of anxiety either alone or in interaction with other variables in a diathesis-stress model. These findings from a prospective longitudinal study are discussed in relation to the potential role of such predictors in primary or relapse prevention efforts.

Anxiety sensitivity and illicit sedative use among opiate-dependent women and men.

Objectives: Research has suggested that individuals with elevated anxiety sensitivity (AS) (the fear of benign bodily sensations associated with anxiety) are more likely to use substances to cope with distress, particularly substances with arousal-dampening effects such as benzodiazepines and other sedatives. Such coping motives may also vary as a function of gender, with women more likely to use substances for coping (self-medicating) purposes. Given these findings, we hypothesized that AS would be associated with illicit sedative use in an opioid-dependent sample and that gender would moderate this relationship, with a greater association among women. Method: Participants were 68 opioid-dependent patients recruited from a methadone maintenance clinic. A logistic regression was used to determine whether AS was associated with presence or absence of a history of illicit sedative use. Results: AS was significantly associated with sedative use and this relationship was moderated by gender; elevated AS was associated with greater sedative use only in women. Conclusion: The presence of elevated AS is related to greater illicit use of sedatives in women but not in men. Women may be more susceptible to seek sedatives as a means of coping with unpleasant, anxious sensations.

The Role of Anxiety Sensitivity and Eating Expectancy in Maladaptive Eating Behavior

Research has shown that anxiety sensitivity (AS), or the fear of somatic arousal, predicts distress and maladaptive coping in a range of psychiatric conditions. More recently, the role of AS has been examined in pathological eating. In the current investigation, a two-study design was employed to examine the role of AS and eating expectancies in both self-reported and actual eating behavior. For Study 1, 42 overweight/obese participants completed questionnaires assessing AS, as well as eating behaviors and attitudes. In Study 2, 60 participants representing all weight ranges completed the same questionnaire battery and underwent a negative mood induction task followed by food exposure. Results of this study revealed a 3-way interaction between Anxiety Sensitivity Index-mental concerns subscale, Eating Expectancy Inventory—eating leads to feeling out of control subscale, and BMI suggesting that those elevated on all 3 constructs consumed the most calories. Results are discussed in relation to better understanding the role of AS and eating expectancy and its utility in identifying a subset of overweight/obese individuals at risk for maladaptive eating behavior.

Clarifying the Link Between Distress Intolerance and Exercise: Elevated Anxiety Sensitivity Predicts Less Vigorous Exercise

Anxiety sensitivity, one measure of distress intolerance, has been increasingly shown to play a role in a variety of health behaviors. A number of reports now suggest that individuals with higher levels of anxiety sensitivity (AS) are less likely to engage in exercise. However, this finding has been inconsistent across sex and limited by measurement strategy. This study examined the relationship between AS and self-reported exercise in a mixed-sex sample of 233 individuals. Consistent with prediction, AS was negatively associated with engagement in vigorous-intensity exercise; however, the strength of this association when covarying for sex was dependent on the measurement strategy used (continuous vs. categorical ASI scores). Sex did not moderate the AS-vigorous exercise association. AS was not associated with moderate-intensity exercise or walking. Results suggest a role of distress intolerance in exercise behavior and confirm the importance of continued research on this topic.

The role of perceived belongingness to a drug subculture among opioid-dependent patients.

Illicit drug use frequently occurs in a context of a drug subculture characterized by social ties with other drug users, feelings of excitement and effectiveness deriving from illicit activities, and alienation from mainstream society. Identification with this subculture is recognized anecdotally as a barrier to recovery, but clear quantification of individual differences in perceived belongingness to the drug subculture has been absent from the literature. The purpose of this study was to describe the development and psychometric properties of a brief self-report measure designed to assess this construct, the Belongingness to Drug Culture Questionnaire (BDCQ). Ninety-six opioid-dependent, methadone-maintained participants completed the BDCQ, related self-report measures, and assessment of drug use patterns. The BDCQ demonstrated high internal consistency (α = .88) and was significantly associated with self-reported days of drug use in the past 30 days, desire to quit, impulsivity, psychopathy, and social, enhancement, and coping drug use motives. These findings encourage continued psychometric evaluation of the BDCQ and study of the role of belongingness in the development and maintenance of substance use disorders.

A novel method for assessing distress intolerance: adaptation of a measure of willingness to pay.

BACKGROUND AND OBJECTIVES Distress intolerance is a core element of many models of psychopathology and is related to a range of disorders and maladaptive behaviors. However, research on distress intolerance has been hampered by inconsistency in its assessment. Moreover, recent perspectives suggest that distress intolerance varies based on the domain of distress, highlighting the need for a measure that can capture intolerance across types of distress. This paper introduces a novel measure for distress intolerance: an adaptation of the willingness to pay (WTP) measure, which provides a consistent metric for assessing distress intolerance across domains of distress. METHODS The WTP Distress Intolerance (WTP-DI) measure was administered to two samples of participants and feasibility and validity were evaluated. RESULTS Evidence from unselected and clinical samples provide evidence for the feasibility and discriminant and concurrent validity of this measure. LIMITATIONS Testing WTP-DI in larger samples and across additional domains of distress is needed. CONCLUSIONS The WTP-DI measure provides a new measure of distress intolerance that addresses the primary limitations of existing measures and has potential to serve as a cross domain measure to facilitate comparison across types of distress.