Charles P. Brandt

Developing scales measuring disorder-specific intolerance of uncertainty (DSIU): A new perspective on transdiagnostic

Intolerance of uncertainty (IU) is a construct of growing prominence in literature on anxiety disorders and major depressive disorder. Existing measures of IU do not define the uncertainty that respondents perceive as distressing. To address this limitation, we developed eight scales measuring disorder-specific intolerance of uncertainty (DSIU) relating to various anxiety disorders and major depressive disorder. We used exploratory factor analysis and item characteristic curves in two large undergraduate samples (Ns=627 and 628) to derive eight three-item DSIU scales (24 items total) that exhibited excellent psychometric properties. Confirmatory factor analysis supported the factor structures of the scales and the transdiagnostic nature of IU. Each scale predicted unique variance in its respective symptom measure beyond a traditional measure of IU. DSIU represents a theoretically proximal and causal intermediary between known vulnerability factors and disorder symptomatology. The DSIU scales can be used to advance theories of psychopathology and inform case conceptualization and treatment planning.

Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature

There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning.

The Examination of Emotion Dysregulation as a Moderator of Depression and HIV-Relevant Outcome Relations Among an HIV+Sample

The present study examined whether emotion dysregulation moderated the relations between depressive symptoms and HIV symptoms, HIV medication adherence due to medication side effects, avoidant coping, and distress tolerance among people living with HIV/AIDS (PLHA). Participants included 115 PLHA (16.8% female; Mage = 49.70, SD = 8.57). Results indicated that there was a significant interaction between depressive symptoms and emotion dysregulation in relation to HIV symptoms, HIV medication adherence due to medication side effects, avoidant coping, and distress tolerance. The form of the interaction indicated that PLHA experiencing higher depressive symptoms and higher levels of emotion dysregulation reported the highest levels of HIV symptoms and lowest levels of distress tolerance. Additionally, results indicated that at lower levels of depressive symptoms, very high levels of emotion dysregulation predicted higher rates of medication nonadherence, whereas at higher levels of depressive symptoms, very high levels of emotion dysregulation predicted the lowest rates of medication nonadherence. Moreover, those experiencing lower levels of depressive symptoms and higher levels of emotion dysregulation reported the greatest rates of avoidant coping. In total, the present results suggest a complex interplay between emotion dysregulation and depressive symptoms with regard to HIV symptoms, medication nonadherence, and self-regulatory processes (e.g., avoidant coping, distress tolerance) among PLHA.

Main and interactive effects of emotion dysregulation and breath-holding duration in relation to panic-relevant fear and expectancies about anxiety-related sensations among adult daily smokers.

The current study investigated the main and interactive effects of emotion dysregulation and distress tolerance in relation to panic-relevant variables among daily smokers. The sample consisted of 172 adults (61.2% male; M(age)=31.58, SD=11.51), who reported smoking an average of 15.99 cigarettes per day (SD=10.00). Results indicated that both emotion dysregulation and distress tolerance were significantly related to interoceptive fear and agoraphobia. Additionally, emotion dysregulation, but not distress tolerance, was significantly related to anxiety sensitivity. All effects were evident above and beyond the variance accounted for by average cigarettes per day, tobacco-related physical illness, and panic attack history. The interaction between emotion dysregulation and distress tolerance significantly predicted interoceptive and agoraphobic fears as well as the cognitive component of anxiety sensitivity. Such findings underscore the importance of emotion dysregulation and distress tolerance in regard to panic-specific fear and expectancies about anxiety-related sensations among daily smokers.

The mediating role of anxiety sensitivity in the relation between avoidant coping and posttraumatic stress among trauma-exposed HIV+ individuals.

The current study examined the mediating role of anxiety sensitivity in regard to the relation between avoidant coping and posttraumatic stress (PTS) symptoms among trauma-exposed persons living with HIV/AIDS (PLHA). Participants included 103 PLHA (18.4% female, Mage = 48.33, SD = 9.34). Results indicated significant positive indirect effects for avoidant coping through anxiety sensitivity on overall PTS symptoms (point estimate = .27, PB 95% CI [.01, .65]), PTS hyperarousal symptoms (point estimate = .09, PB 95% CI [.01, .21]), and PTS avoidant symptoms (point estimate = .14, PB 95% CI [.03, .30]). The observed findings were statistically significant and evident above and beyond the variance accounted for by CD4 cell count, race, sex, recruitment site, and lifetime number of traumatic events experienced. The results may indicate that avoidant coping affects PTS symptoms through anxiety sensitivity among trauma-exposed PLHA. These findings highlight the importance of anxiety sensitivity in relation to PTS symptoms among PLHA, and the possibility of adapting anxiety sensitivity reduction training for PTS symptoms among PLHA.

Anxiety sensitivity and hazardous drinking among persons living with HIV/AIDS: An examination of the role of emotion dysregulation

Hazardous drinking is prevalent among persons living with HIV/AIDS (PLWHA). Anxiety sensitivity is a vulnerability factor that is highly associated with hazardous drinking among seronegatives, but has yet to be tested in PLWHA. Additionally, there is a need to examine potential mechanisms underlying associations of anxiety sensitivity and hazardous drinking. Emotion dysregulation is one potential construct that may explain the association between anxiety sensitivity and hazardous drinking. The current study examined emotion dysregulation as a potential explanatory variable between anxiety sensitivity and four, clinically significant alcohol-related outcomes among PLWHA: hazardous drinking, symptoms of alcohol dependence, number of days consuming alcohol within the past month, and degree of past heavy episodic drinking. The sample included 126 PLWHA (Mage=48.3; SD=7.5; 65.9% male). Results indicated significant indirect effects of anxiety sensitivity via emotion dysregulation in all models. Indirect effects (κ(2)) were of medium effect size. Alternative models were run reversing the predictor with mediator and, separately, reversing the mediator with the proposed outcome(s); alternative models yielded non-significant indirect effects in all but one case. Together, the current results indicate that anxiety sensitivity is associated emotion dysregulation, which, in turn, is associated with hazardous drinking outcomes. Overall, these findings may provide initial empirical evidence that emotion dysregulation may be a clinical intervention target for hazardous drinking.

Predictors of breath-holding duration among treatment-seeking tobacco users

Abstract Breath-holding duration is a commonly used measure of behavioral distress intolerance and an important predictor of smoking cessation abstinence during quit attempts. Yet, the there is little empirical knowledge about the factors that may underlie breath-holding duration itself. The current study examined a variety of bio-behavioral factors in the prediction of breath-holding duration among smokers. Participants were 120 daily smokers (Mage = 29.1; 47% Female) who were seeking treatment for smoking cessation. Results indicated that perceived discomfort intolerance (β = −0.20, p < 0.05; measured by the Discomfort Intolerance Scale) and frustration tolerance (measured by mirror-tracing task persistence; β = −0.25, p < 0.01) were significantly associated with breath-holding duration, such that smokers reporting lower perceived discomfort intolerance and shorter task-persistence demonstrated a significantly lower capacity to maintain breath-holding. Importantly, the observed significant effects were evident above the variance accounted for by cigarette use, number of past quit attempts, physical health problems, gender, anxiety sensitivity (fear of internal aversive sensations), and psychopathology. The present results suggest that breath-holding duration is related to other distress intolerance processes rather than a relatively wide array of other psychological, medical, and sociodemographic factors.

Cultural-based biases of the GAD-7.

The GAD-7 is a popular measure of generalized anxiety disorder (GAD) symptoms that has been used across many cultural groups. Existing evidence demonstrates that the prevalence of GAD varies across self-identified ethnic/cultural groups, a phenomenon that some researchers attribute to cross-cultural measurement error rather than to actual differences in rates of GAD. Nonetheless, the effect of culture on factor structure and response patterns to the GAD-7 have not been examined and could result over- or under-estimated GAD-7 scores across different cultural groups. The current investigation assessed the factor structure of the GAD-7 in White/Caucasian, Hispanic, and Black/African American undergraduates and tested for cultural-based biases. A modified one-factor model exhibited good fit across subsamples. Results revealed that Black/African American participants with high GAD symptoms scored lower on the GAD-7 than other participants with similar GAD symptoms. Results highlight the need for culturally sensitive GAD screening tools.

The moderating role of smoking amount per day on the relations between anxiety sensitivity, smoking dependence, and cognitive–affective aspects of smoking among treatment seeking smokers

The current study examined the moderating effects of smoking amount per day on the relation between anxiety sensitivity and nicotine dependence, cigarette smoking outcome expectancies, and reasons for quitting smoking among 465 adult, treatment-seeking smokers (48% female; Mage = 36.6, SD = 13.5). Smoking amount per day moderated the relation between anxiety sensitivity and nicotine dependence, smoking expectancies for negative consequences and appetite control as well as intrinsic reasons for quitting. However, no moderating effect was evident for negative reinforcement expectancies. The form of the significant interactions indicated across dependent variables lower levels of smoking amount per day suppressed the relation between anxiety sensitivity and smoking related dependent variable, such that the positive relation of anxiety sensitivity to smoking dependence and cognitive–affective aspects of smoking is weaker in heavier smokers and more robust in lighter smokers.

Examining anxiety sensitivity as an explanatory construct underlying HIV-related stigma: Relations to anxious arousal, social anxiety, and HIV symptoms among persons living with HIV

Persons living with HIV (PLHIV) are a health disparity subgroup of the overall population for mental and physical health problems. HIV-related stigma has been shown to increase anxiety symptoms and HIV symptoms among PLHIV. However, little is known about factors that may impact the relations between HIV-related stigma and anxiety symptoms and HIV symptoms among PLHIV. To address this gap in the literature, the current study examined anxiety sensitivity (i.e., the extent to which individuals believe anxiety and anxiety-related sensations) in the relation between HIV-related stigma, social anxiety, anxious arousal, and HIV symptoms among a sample of 87 PLHIV (60.9% cis gender male, 52.9% Black, non-Hispanic). Results indicated that anxiety sensitivity mediated the relations between HIV-related stigma and the dependent variables, with effect sizes indicating moderate to large effects of anxiety sensitivity on these relations. Findings suggest that anxiety sensitivity be a mechanistic factor in the relations between HIV-related stigma and social anxiety, anxious arousal, and HIV symptoms, and therefore, be important element in efforts to reduce mental/physical health disparity among this population.