Brooke Y. Kauffman

Exercise augmentation of exposure therapy for PTSD: Rationale and pilot efficacy data

Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial for long-term learning and memory. Some studies suggest that people suffering from anxiety disorders show reduced BDNF relative to healthy controls. Lower BDNF is associated with impaired learning, cognitive deficits, and poor exposure-based treatment outcomes. A series of studies with rats showed that exercise elevates BDNF and enhances fear extinction. However, this strategy has not been tested in humans. In this pilot study, we randomized participants (N = 9, 8 females, MAge = 34) with posttraumatic stress disorder (PTSD) to (a) prolonged exposure alone (PE) or (b) prolonged exposure+exercise (PE+E). Participants randomized to the PE+E condition completed a 30-minute bout of moderate-intensity treadmill exercise (70% of age-predicted HRmax) prior to each PE session. Consistent with prediction, the PE+E group showed a greater improvement in PTSD symptoms (d = 2.65) and elevated BDNF (d = 1.08) relative to the PE only condition. This pilot study provides initial support for further investigation into exercise augmented exposure therapy.

Psychometric evaluation of the Barriers to Cessation Scale.

The Barriers to Cessation Scale (BCS; Macnee & Talsma, 1995a) was developed to assess global and specific perceived barriers that may interfere with the quit process. Although the BCS is widely used in the literature, little scientific work has been devoted to examining the psychometric properties of the measure. Thus, the present study sought to address this gap by evaluating the BCS in a sample of 497 treatment-seeking smokers. The current study examined the factor structure of the BCS, measurement invariance of the BCS subscales across sex and over 2 time points, and evaluated construct validity. Results indicated that the BCS was best modeled by a higher order factor structure wherein the originally proposed 3-factor solution (Addiction, External, and Internal) constituted the lower order and a global factor constituted the higher order factor. The higher order BCS structure demonstrated partial measurement invariance across sex and full measurement invariance from baseline to quit day among treatment seeking smokers. Additionally, expected relations were observed between the BCS subscales and similar and divergent constructs, and predictive validity was partially supported. The current findings provide novel empirical evidence that the BCS is a reliable measure of perceived barriers to smoking cessation across multiple domains and is related to several affective and smoking processes the may interfere with the process of quitting.

Negative Affectivity and Problematic Alcohol Use Among Latinos in Primary Care: The Role of Emotion Dysregulation

Objective: Latinos are the largest and most rapidly growing racial/ethnic group in the United States. In Latino communities, alcohol is the most widely abused substance, yet there is little empirical understanding of the factors underlying problematic alcohol use among Latinos. The current study explored whether negative affectivity exerted an indirect effect via emotion dysregulation in relation to two alcohol-related outcomes. Methods: Participants were 316 Latinos attending a community-based primary care facility (Mage = 39.3, SD = 11.3; 85.4% female; 95.3% first language Spanish), who completed a variety of self-report and interview measures. Mediation analyses evaluated the indirect effect of negative affectivity via emotion dysregulation on problematic drinking and symptoms of alcohol dependence. Results: While there was no direct or total effect of negative affectivity on either alcohol-related outcome, negative affectivity was significantly associated with both problematic alcohol use and symptoms of dependence via emotion dysregulation. Effect sizes were in the medium range, K2 = .09 and .10, respectively. Post-hoc multiple mediation analyses evaluated subfactors of emotion dysregulation as mediators of the negative affectivity–alcohol associations. These results suggested that difficulties engaging in goal-directed behavior might be particularly important in explaining the association between negative affectivity and problematic alcohol use/symptoms of dependence. Last, independent mediation analyses evaluated emotion dysregulation subfactors and found that limited access to effective emotion regulation strategies and difficulties engaging in goal-directed behavior were, independently, significant mediators for both outcomes. Nonacceptance of emotional responses may also mediate negative affectivity and problematic drinking. Surprisingly, impulse control difficulties was not a significant mediator in any model. Conclusions: These data provide novel insight that among Latinos in primary care, emotion dysregulation is a possible mechanism underlying the indirect relationship between negative affectivity and problematic alcohol use and symptoms of dependence. Results also highlight specific facets of emotion dysregulation as potential targets of intervention. Future research should be longitudinal in nature, be conducted among more representative samples, and utilize measures that will better assess the potential variability in these associations. Results of such work may inform the development of alcohol treatment interventions incorporating the use of adaptive emotion regulation among Latinos in primary care.

Effects of anxiety sensitivity reduction on smoking abstinence: An analysis from a panic prevention program.

Objective: Scientific evidence implicates anxiety sensitivity (AS) as a risk factor for poor smoking cessation outcomes. Integrated smoking cessation programs that target AS may lead to improved smoking cessation outcomes, potentially through AS reduction. Yet, little work has evaluated the efficacy of integrated smoking cessation treatment on smoking abstinence. The present study prospectively examined treatment effects of a novel AS reduction-smoking cessation intervention relative to a standard smoking cessation intervention on smoking abstinence. Method: Participants (N = 529; 45.9% male; Mage = 38.23, SD = 13.56) included treatment-seeking smokers who received either a 4-session integrated anxiety-reduction and smoking cessation intervention (Smoking Treatment and Anxiety Management Program; [STAMP]) or a 4-session standard smoking cessation program (SCP). The primary aims focused on examining the effects of STAMP on (a) AS reduction during treatment, (b) early and late smoking point prevalence abstinence, and (c) the mechanistic function of AS reduction on treatment effects across early and late smoking abstinence. Results: Results indicated a significantly greater decline in AS in STAMP relative to SCP (B = −.72, p < .001). Treatment condition did not significantly directly predict early or late abstinence. However, the effect of STAMP on early abstinence was significantly mediated by reductions in AS (indirect = .16, 95% CI [.02, .40]). Conclusions: Findings provide evidence for the efficacy of a novel, integrated anxiety and smoking cessation treatment to reduce AS. Moreover, the meditation pathway from STAMP to early abstinence through reductions in AS suggest that AS is a clinically important mechanism of change for smoking cessation treatment and research.

Synergistic effects of pain intensity and experiential avoidance in relation to anxiety symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting

Latinos are subject to numerous health inequalities, including mental health disparity for anxiety and its disorders. In fact, there is strikingly little understanding of transdiagnostic risk factors for the onset and development of anxiety symptoms and disorders among Latinos. To build knowledge in this domain, the present investigation examined the interactive effects of experiential avoidance and pain intensity in relation to anxious arousal, social anxiety, and anxiety disorders among 361 Latino adults with annual incomes of less than

Anxiety sensitivity and smoking variability among treatment seeking smokers

30,000 (87.5% female; Mage=38.8, SD=11.4, and 98.5% used Spanish as their first language) who attended a community-based primary healthcare clinic. As hypothesized, the interaction between experiential avoidance and pain intensity was significantly related to anxious arousal, social anxiety, and a number of anxiety disorders over and above the effects of other factors. The form of the significant interactions indicated that participants reporting co-occurring higher levels of experiential avoidance and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between experiential avoidance and pain intensity in regard to a relatively wide array of anxiety problems among Latinos in a primary care medical setting.

Does exercise aid smoking cessation through reductions in anxiety sensitivity and dysphoria

Objectives:Anxiety sensitivity (AS) is associated with poor smoking cessation outcomes. One reason may be that smokers with high AS smoke differently (ie, to manage negative affect and uncomfortable bodily sensations) than other smokers, leading to stronger addiction (due to an affect/sensation based and thereby highly variable rather than a regular smoking routine). Thus, we examined the relationship between AS and smoking variability in a group of treatment-seeking smokers. Methods:Participants (N=136; 52.2% female; Mage=44.19 y, SD=11.29) were daily smokers with elevated AS (AS≥20 on the Anxiety Sensitivity Index 16-item at prescreen) recruited as part of a larger randomized controlled trial for smoking cessation. Most participants were white (73%), educated (with 76% attending some college), unmarried (73%), and employed full-time (56%). They smoked, on average, 17 cigarettes per day. Results:Consistent with prediction, a regression analysis of baseline assessments and a longitudinal analysis with multilevel modeling both showed higher AS was associated with greater variability in cigarettes smoked per day while controlling for sex, age, ethnicity, and income. Conclusions:This finding encourages investigation of how AS might interact with clinical strategies using a fixed smoking taper as part of quit attempts.

Financial strain and cognitive-based smoking processes: The explanatory role of depressive symptoms among adult daily smokers.

Objective: Research shows that high anxiety sensitivity (AS) and dysphoria are related to poor smoking cessation outcomes. Engaging in exercise may contribute to improvement in smoking cessation outcomes through reductions in AS and dysphoria. In the current study, we examined whether exercise can aid smoking cessation through reductions in AS and dysphoria. Method: Participants were sedentary and low activity adult daily smokers (N = 136) with elevated AS who participated in a randomized controlled trial comparing smoking cessation treatment (ST) plus an exercise intervention (ST + EX) to ST plus wellness education (ST + CTRL). Self-reported smoking status was assessed in-person weekly from baseline through week 16 (end of-treatment; EOT), at week 22 (4 months postquit day), and at week 30 (6 months postquit day), and verified biochemically. Results: Results indicated that both AS and dysphoria at 6-month follow-up were significantly lower in the ST + EX group compared to the ST + CTRL group (controlling for baseline levels). Moreover, reductions in AS and dysphoria emerged as independent mechanisms of action explaining success in quitting. Conclusions: These novel findings offer clinically significant evidence suggesting that vigorous-intensity exercise can effectively engage affective constructs in the context of smoking cessation.

Emotion dysregulation explains the relation between insomnia symptoms and negative reinforcement smoking cognitions among daily smokers

Little work has focused on the underlying mechanisms that may link financial strain and smoking processes. The current study tested the hypothesis that financial strain would exert an indirect effect on cognitive-based smoking processes via depressive symptoms. Three clinically significant dependent variables linked to the maintenance of smoking were evaluated: negative affect reduction motives, negative mood abstinence expectancies, and perceived barriers for quitting. Participants included 102 adult daily smokers (Mage=33.0years, SD=13.60; 35.3% female) recruited from the community to participate in a self-guided (unaided; no psychological or pharmacological intervention) smoking cessation study. Results indicated that depressive symptoms explain, in part, the relation between financial strain and smoking motives for negative affect reduction, negative mood abstinence expectancies, and perceived barriers for quitting. Results indicate that smoking interventions for individuals with high levels of financial strain may potentially benefit from the addition of therapeutic tactics aimed at reducing depression.

Treatment attrition: Associations with negative affect smoking motives and barriers to quitting among treatment-seeking smokers

INTRODUCTION Insomnia co-occurs with smoking. However, mechanisms that may explain their comorbidity are not well known. METHOD The present study tested the hypothesis that insomnia would exert an indirect effect on negative reinforcement smoking processes via emotion dysregulation among 126 adult non-treatment seeking daily smokers (55 females; Mage=44.1years, SD=9.72). Negative reinforcement smoking processes included negative reinforcement smoking outcome expectancies, negative reinforcement smoking motives, and two negative expectancies from brief smoking abstinence (somatic symptoms and harmful consequences). RESULTS Insomnia symptoms yielded a significant indirect effect through emotion dysregulation for negative reinforcement smoking outcome expectancies, negative reinforcement smoking motives, and harmful consequences expectancies from brief smoking abstinence. In contrast to prediction, however, insomnia was not associated with somatic symptom expectancies from brief smoking abstinence through emotion dysregulation. CONCLUSIONS These data may suggest that the indirect effect of emotion dysregulation is more relevant to cognitive-affective negative reinforcement processes rather than somatic states. Overall, the present findings contribute to a growing body of literature linking emotion dysregulation as an explanatory mechanism for insomnia and smoking and uniquely extend such work to an array of clinically significant negative reinforcement smoking processes.