Carrie M. Potter

Posttraumatic stress and marijuana use coping motives: The mediating role of distress tolerance

The present investigation examined the explanatory (i.e,. mediating) role of distress tolerance (DT) in the relation between posttraumatic stress (PTS) symptom severity and marijuana use coping motives. The sample consisted of 142 adults (46.5% women; M(age) = 22.18, SD = 7.22, range = 18-55), who endorsed exposure to at least one Criterion A traumatic life event (DSM-IV-TR, 2000) and reported marijuana use within the past 30 days. As predicted, results demonstrated that DT partially mediated the relation between PTS symptom severity and coping-oriented marijuana use. These preliminary results suggest that DT may be an important cognitive-affective mechanism underlying the PTS-marijuana use coping motives association. Theoretically, trauma-exposed marijuana users with greater PTS symptom severity may use marijuana to cope with negative mood states, at least partially because of a lower perceived capacity to withstand emotional distress.

Association Between Exercise and Posttraumatic Stress Symptoms Among Trauma-Exposed Adults

The present investigation examined associations between intensities of exercise involvement and posttraumatic stress (PTS) symptom cluster severity (reexperiencing, avoidance/numbing, and hyperarousal). The sample was comprised of 108 adults (54.6% women; M age = 23.9, SD = 10.22, range = 18–62), who endorsed exposure to a Diagnostic and Statistical Manual of Mental Disorders (Fourth edition, Text Revision) posttraumatic stress disorder Criterion A traumatic life event but did not meet criteria for any current Axis I psychopathology. After controlling for gender and lifetime number of trauma exposure types experienced, results indicated that vigorous-intensity exercise, but not light- or moderate-intensity exercise, was significantly inversely associated with hyperarousal symptom cluster severity. This study adds to the scarce, yet growing, body of exercise—PTS literature—by illuminating the inverse associations of vigorous-intensity exercise, specifically, and PTS hyperarousal symptom severity among trauma-exposed individuals.

Correlates of life satisfaction among aging veterans.

BACKGROUND The purpose of this study was to document the associations of stressors (combat exposure, retirement concerns, and late-life stressful events), personal resources (social support, sense of mastery, and positive appraisal of military experiences), and functional health (both physical and mental) with life satisfaction in older veterans. METHODS Participants were 562 male combat veterans (mean age = 70). Self-report questionnaires were administered via mail survey. A hierarchical multiple regression analysis was performed. RESULTS Each step of the regression analysis demonstrated a significant contribution to variance in life satisfaction (48% in total). Although stressors were significant when entered as a set, their influence dissipated in the presence of personal resources and functional health. For the full model, seven of 11 independent variables were unique and significant predictors, including all personal resource factors and both functional health indices. Sense of mastery was most potent. CONCLUSIONS Even in the presence of stressors, personal resources and functional health appear to serve protective roles in explaining levels of life satisfaction among aging veterans.

Distinguishing late-onset stress symptomatology from posttraumatic stress disorder in older combat veterans.

Objective: To assess the discriminant validity of late-onset stress symptomatology (LOSS) in terms of its distinction from posttraumatic stress disorder (PTSD). Method: The LOSS Scale, PTSD Checklist – Civilian Version, and related psychological measures were administered to 562 older male combat veterans via a mailed questionnaire. Analyses focused on: (a) comparing associations of LOSS and PTSD with other psychological variables and (b) examining a hypothesized curvilinear relationship between LOSS and PTSD scores. Results: Compared to PTSD, LOSS was more strongly associated with concerns about retirement and less strongly associated with depression, anxiety, sense of mastery, and satisfaction with life. LOSS also demonstrated a curvilinear relationship with PTSD, such that the positive association between LOSS and PTSD diminished at higher levels of PTSD. Conclusion: LOSS is conceptually and statistically more strongly associated with a normative late-life stressor than is PTSD, but is less strongly related to mental health symptoms and emotional well-being. Additionally, LOSS seems more related to subthreshold PTSD than it is to clinically significant PTSD. The present findings support the discriminant validity of LOSS.

Computerized Tool to Manage Dental Anxiety: A Randomized Clinical Trial

Anxiety regarding dental and physical health is a common and potentially distressing problem, for both patients and health care providers. Anxiety has been identified as a barrier to regular dental visits and as an important target for enhancement of oral health–related quality of life. The study aimed to develop and evaluate a computerized cognitive-behavioral therapy dental anxiety intervention that could be easily implemented in dental health care settings. A cognitive-behavioral protocol based on psychoeducation, exposure to feared dental procedures, and cognitive restructuring was developed. A randomized controlled trial was conducted (N = 151) to test its efficacy. Consenting adult dental patients who met inclusion criteria (e.g., high dental anxiety) were randomized to 1 of 2 groups: immediate treatment (n = 74) or a wait-list control (n = 77). Analyses of covariance based on intention-to-treat analyses were used to compare the 2 groups on dental anxiety, fear, avoidance, and overall severity of dental phobia. Baseline scores on these outcomes were entered into the analyses as covariates. Groups were equivalent at baseline but differed at 1-mo follow-up. Both groups showed improvement in outcomes, but analyses of covariance demonstrated significant differences in dental anxiety, fear, avoidance, and overall severity of dental phobia in favor of immediate treatment at the follow-up assessment. Of the patients who met diagnostic criteria for phobia at baseline, fewer patients in the immediate treatment group continued to meet criteria for dental phobia at follow-up as compared with the wait-list group. A new computer-based tool seems to be efficacious in reducing dental anxiety and fear/avoidance of dental procedures. Examination of its effectiveness when administered in dental offices under less controlled conditions is warranted (ClinicalTrials.gov NCT02081365).

Anger profiles in social anxiety disorder

Individuals with social anxiety disorder (SAD) exhibit elevated levels of anger and anger suppression, which are both associated with increased depression, diminished quality of life, and poorer treatment outcomes. However, little is known about how anger experiences differ among individuals with SAD and whether any heterogeneity might relate to negative outcomes. This investigation sought to empirically define anger profiles among 136 treatment-seeking individuals with SAD and to assess their association with distress and impairment. A latent class analysis was conducted utilizing the trait subscales of the State-Trait Anger Expression Inventory-2 as indicators of class membership. Analysis revealed four distinct anger profiles, with greatest distress and impairment generally demonstrated by individuals with elevated trait anger, a greater tendency to suppress the expression of anger, and diminished ability to adaptively control their anger expression. These results have implications for tailoring more effective interventions for socially anxious individuals.

Situational panic attacks in social anxiety disorder.

BACKGROUND Panic attacks (PAs) are common in many psychiatric disorders other than panic disorder, especially social anxiety disorder (SAD). PAs have been associated with increased severity, comorbidity, and impairment in many disorders; therefore, PAs can now be used as a descriptive specifier across all DSM-5 disorders. However, the clinical implications of PAs in SAD remain unclear. METHODS The aim of the present investigation was to examine demographic and clinical characteristics associated with SAD-related situational panic attacks in a large, representative epidemiological sample of individuals with SAD (N=1138). We compared individuals with SAD who did and did not endorse situational PAs in terms of demographic factors, fear/avoidance of social situations, distress, impairment, and diagnostic comorbidity. RESULTS Being male, black, Asian, or over 65 years old was associated with a decreased likelihood of experiencing situational PAs, whereas being unemployed was associated with an increased likelihood. Individuals with situational PAs also exhibited greater fear and avoidance of social situations, impairment, coping-oriented substance use, treatment utilization, and concurrent and longitudinal psychiatric comorbidity. LIMITATIONS Consistent with most epidemiologic studies, the information collected relied on self-report, and not all participants were available for both waves of assessment. CONCLUSIONS The present findings suggest that SAD-related situational PAs are associated with more severe and complex presentations of SAD. Implications for the assessment and treatment of SAD, as well as for the use of PAs as a descriptive specifier for SAD, are discussed.

Social anxiety and vulnerability for problematic drinking in college students: the moderating role of post-event processing.

Abstract Socially anxious college students are at increased risk for engaging in problematic drinking (i.e. heavy or risky drinking) behaviors that are associated with the development of an alcohol use disorder. The present study examined whether post-event processing (PEP), repeatedly thinking about and evaluating one’s performance in a past social situation, strengthens the association between social anxiety and vulnerability to problematic drinking among college students. Eighty-three college drinkers with high or low social anxiety participated in a social interaction task and were exposed to a manipulation that either promoted or inhibited PEP about the social interaction. Among participants randomized to the PEP promotion condition, those with high social anxiety exhibited a greater urge to use alcohol after the social interaction and greater motivation to drink to cope with depressive symptoms over the week following the manipulation than did those with low social anxiety. These findings suggest that targeting PEP in college drinking intervention programs may improve the efficacy of such programs for socially anxious students.

Clinical implications of panic symptoms in dental phobia.

The occurrence of panic symptoms in various anxiety disorders has been associated with more severely impaired and difficult-to-treat cases, but this has not been investigated in dental phobia. We examined the clinical implications of panic symptoms related to sub-clinical and clinically significant dental phobia. The sample consisted of 61 patients at a university dental clinic who endorsed symptoms of dental phobia, 25 of whom met criteria for a formal diagnosis of dental phobia. Participants with dental phobia endorsed more panic symptoms than did those with sub-clinical dental phobia. In the total sample, greater endorsement of panic symptoms was associated with higher dental anxiety, more avoidance of dental procedures, and poorer oral health-related quality of life. Among those with dental phobia, certain panic symptoms exhibited associations with specific anxiety-eliciting dental procedures. Panic symptoms may serve as indicators of clinically significant dental phobia and the need for augmented treatment.

Socially-relevant Panic Symptoms in Social Anxiety Disorder

Panic attacks (PAs) are experienced by approximately half of all individuals with social anxiety disorder (SAD) and are often situationally triggered. Clinical observation suggests that individuals with SAD experience additional “non-traditional” socially-relevant symptoms during PAs. This study examined whether treatment-seeking individuals with SAD (N = 203) endorsed socially-relevant symptoms during PAs and whether these symptoms might be useful in characterizing PAs among these patients. Based on endorsement rates and factor-analytic results, we developed criteria for socially-relevant PAs, and divided the sample into four groups: no PAs (n = 68), socially-relevant PAs only (n = 44), traditional PAs only (n = 22), and combined socially-relevant/traditional PAs (n = 69). Compared to the no-PA group, the combined and socially-relevant PA groups exhibited greater severity of SAD, whereas the traditional PA group did not. Findings suggest that previously reported associations between PAs and greater severity of SAD may be partially explained by the presence of socially-relevant panic symptoms.