C.W. Lejuez

A prospective examination of distress tolerance and early smoking lapse in adult self-quitters

INTRODUCTIONnA significant percentage of smokers attempting cessation lapse to smoking within a matter of days, and current models of relapse devote insufficient attention to such early smoking lapse. Studies attempting to relate severity of nicotine withdrawal symptoms to short-term smoking cessation outcomes have yielded equivocal results. How one reacts to the discomfort of nicotine withdrawal and quitting smoking (i.e., distress tolerance) may be a more promising avenue of investigation with important treatment implications.nnnMETHODSnThe present investigation examined distress tolerance and early smoking lapse using a prospective design. Participants were 81 adult daily smokers recruited through newspaper advertisements targeted at smokers planning to quit smoking without assistance (i.e., no pharmacotherapy or psychosocial treatment; 42 males and 39 females; mean age = 42.6 years, SD = 12.20).nnnRESULTSnAs hypothesized, both greater breath-holding duration and carbon dioxide-enriched air persistence were associated with a significantly lower risk of smoking lapse following an unaided quit attempt. These effects were above and beyond the risk associated with levels of nicotine dependence, education, and history of major depressive disorder, suggesting that distress tolerance and task persistence may operate independently of risk factors such as nicotine dependence and depressive history. In contrast to expectation, persistence on the Paced Auditory Serial Addition Test (a psychological challenge task) was not a significant predictor of earlier smoking lapse.nnnDISCUSSIONnThese results are discussed in relation to refining theoretical models of the role of distress tolerance in early smoking lapse and the utility of such models in the development of specialized treatment approaches for smoking cessation.

Manualized behavior therapy: Merits and challenges

Treatment manuals have been hailed as an important breakthrough in the development, evaluation, and dissemination of empirically validated therapies. Yet manualized behavior therapy has also been criticized because (a) practice involves the application of validated principles of behavior rather than the application of fixed strategies, and (b) successful behavioral interventions must supposedly be based on an idiographic functional problem analysis and tailored to each individual patient. This article evaluates the relative merits, potential limitations, and misconceptions about the use of manuals. We conclude that individualizing treatment and manual use are not mutually exclusive and propose that manuals be used in a flexible theory-driven fashion guided by empirically tested clinical decision rules.

The role of offset control in anxious responding: An experimental test using repeated administrations of 20% carbon dioxide-enriched air.

The present investigation attempted to clarify whether a lack of control affects self-reported anxiety and physiological reactivity during eight administrations of 20% carbon dioxide (CO 2 )-enriched air. Thirty individuals who reported high levels of suffocation fear were randomly assigned to a condition that either permitted or did not permit control over the offset of CO 2 gas inhalation. In contrast to participants with control, participants without control reported significantly more self-reported anxiety and intense panic experiences. Although 20% CO 2 -enriched air reliably evoked physiological arousal for both groups, no significant between-group differences for peripheral indices of somatic reactivity were observed. We discuss the implications of these findings for understanding how control over aversive environmental stimuli mediates anxious responding in panic disorder.

The effects of offset control over 20% carbon-dioxide-enriched air on anxious responding.

Control over the offset of repeated administrations of 20% carbon-dioxide-enriched air was assessed in nonclinical participants (n = 30) reporting elevated levels of anxiety sensitivity--a population at an increased risk for experiencing panic attacks and possibly developing panic disorder. In Phase I, participants were randomly assigned to 1 of 2 conditions: one that permitted offset control over gas inhalation and one that did not. These conditions were reversed in Phase II. Across phases, a lack of offset control resulted in greater self-reported anxiety compared with having control, although no significant differences were observed for heart rate. Whereas all participants demonstrated a Stroop interference effect for general (e.g., coffin) compared with specific (e.g., dizzy) physical threat word types prior to the first experimental phase, this effect persisted only for participants who had offset control in Phase I. We discuss these results in relation to the differential effects of offset control, with implications for better understanding anxious responding during elevated bodily arousal.

Devices and methods for administering carbon dioxide-enriched air in experimental and clinical settings

Although researchers successfully have used carbon dioxide-enriched air in experimental and clinical preparations, its functional properties may differ across laboratories due to procedural differences. Additionally, current procedures may be too simplistic for more complex experimental designs. To address these issues, we present three devices for administering carbon dioxide-enriched air. Although these devices differ concerning variables such as mode of operation, ease and cost of implementation, and complexity of experimental designs that may be undertaken, a reasonable level of standardization may be achieved because the inhalations experienced by participants are functionally equivalent across devices. We discuss advantages and disadvantages of these devices regarding experimental panic provocation and aversive conditioning preparations.

Prediction and control: operational definitions for the experimental analysis of anxiety.

Prediction and/or control of threatening events generally results in less pronounced anxiety-related responding compared to when those same events are unpredictable or uncontrollable. For this reason, researchers have suggested that predictability and controllability may modulate anxiety-related responding, thereby serving an important role in the development and progression of anxiety pathology. Despite the recognized importance of prediction and control for anxiety, these variables have not been defined or operationalized in a uniform and unambiguous manner. In this article, we propose an operational definition that defines and distinguishes prediction and control in terms of the onset and offset of an aversive event. This operationalization is aimed at facilitating experimental-based efforts to explore the independent and interactive effects of the prediction and control on anxious responding.

Predictors of Self-Reported Anxiety and Panic Symptoms: An Evaluation of Anxiety Sensitivity, Suffocation Fear, Heart-Focused Anxiety, and Breath-Holding Duration

The purpose of this study was to examine the extent to which anxiety-related individual difference variables predict anxious responding when individuals experience aversive bodily sensations. Thus, we explore several psychological and behavioral predictors of response to a single 25-sec inhalation of 20% carbon dioxide-enriched air in 70 nonclinical participants. Predictor variables included anxiety sensitivity, suffocation fear, heart-focused anxiety, and breath-holding duration. Multiple regression analyses indicated that only anxiety sensitivity significantly predicted postchallenge panic symptoms, whereas both anxiety sensitivity and suffocation fear predicted postchallenge anxiety. These data are in accord with current models of panic disorder that emphasize the role of “fear of fear” in producing heightened anxiety and panic symptoms and help clarify specific predictors of anxiety-related responding to biological challenge.

Preference between onset predictable and unpredictable administrations of 20% carbon-dioxide-enriched air: implications for better understanding the etiology and treatment of panic disorder.

Predictability of aversive events impacts the development and maintenance of anxiety, particularly panic disorder. Although animal studies typically have found a preference for signaled (predictable) over unsignaled (unpredictable) aversive events, results of research with human participants have been less clear. Using a panic-relevant paradigm, the authors examined predictability preference with humans as a function of anxiety sensitivity and gender during repeated administrations of 20% carbon-dioxide-enriched air. Participants preferred predictable administrations, with high-anxiety individuals showing greater preference than low-anxiety individuals and women showing greater preference than men. In addition to providing information to better understand human predictability preference for panic-related events, results also may aid in determining the applicability of predictability to the cognitive-behavioral treatment of panic disorder.

Moving From the Laboratory to the Real World and Back Again: Increasing the Relevance of Laboratory Examinations of Anxiety Sensitivity.

Laboratory-based experimental research has led to important breakthroughs in our understanding and treatment of anxiety disorders as well as other types of psychopathology. Despite the importance of this work, the relevance of laboratory-based research using clinical and nonclinical populations has been understated—particularly given concerns about the ecological and external validity of this research. Although some of these issues have been addressed elsewhere, there continues to be less emphasis on laboratory-based investigations compared to other types of research (e.g., treatment outcome). There also is continued misunderstanding regarding what questions can be examined and answered by experimental studies. As an introduction to this special series on the relevance of laboratory examinations of anxiety, we suggest that advances in laboratory preparations can make significant contributions to current behavior therapy. We also suggest that observations in clinical practice can spur innovations in laboratory research. One theme echoed by the articles in this miniseries is the need for a renewed commitment to reestablishing a link between laboratory-based research and clinical application as a means to further advance the science and practice of behavior therapy over the long-term.

Cognitive vs. contextual causation: Different world views but perhaps not irreconcilable

In this commentary, we address some of the divisive issues between cognitive theorists and behavior analysts concerning the aims and goals of science and differing views of causality. We suggest that evidence for the causal status of cognition has been inconclusive, largely due to the fact that most of this research can be framed in terms of environmental causes. We examine (1) what we can consider as causes of behavior and (2) how we can manipulate these causes in therapy. We conclude that a rapprochement between cognitivists and behavior analysts will require more careful description of the multiple causal pathways responsible for experimental and therapeutic effects.