Jessica F. Magidson

Behavioral and Biological Indicators of Impulsivity in the Development of Alcohol Use, Problems, and Disorders

Alcohol use disorders (AUDs) are a devastating public health problem. The construct of impulsivity is biologically based and heritable, and its various dimensions are relevant for understanding alcohol use. The goal of the current manuscript is to review recent behavioral and biological research examining various dimensions of impulsivity and their relation to AUDs from risk for initial use through dependence and relapse. Moreover, we also highlight key psychological variables including affective processes as they relate to current use and early indications of alcohol problems, as well as psychopathology, violence, and aggression in relation to AUDs. Each section includes a critical summary and we conclude the review with future directions focused on issues relevant to measurement, causality, and intervention. Throughout the review, we attempt to be as specific as possible about the dimensions of impulsivity being referenced, while attempting to draw parallels and highlighting differences as the existing literature allows.

Changes in sensation seeking and risk-taking propensity predict increases in alcohol use among early adolescents

BACKGROUND Conceptual models implicating disinhibitory traits often are applied to understanding emergent alcohol use, but, little is known of how inter-individual changes in these constructs relate to increases in alcohol use in early adolescence. The current study utilized behavioral and self-report instruments to capture the disinhibitory-based constructs of sensation seeking and risk-taking propensity to examine if increases in these constructs over time related to increases in early adolescent alcohol use. METHODS Participants included a community sample of 257 early adolescents (aged 9 to 12) who completed a self-report measure of sensation seeking, a behavioral task assessing risk-taking propensity, and a self-report of past year alcohol use, at 3 annual assessment waves. RESULTS Both sensation seeking and risk-taking propensity demonstrated significant increases over time, with additional evidence that change in the behavioral measure of risk-taking propensity was not because of practice effects. Greater sensation seeking and greater risk-taking propensity demonstrated concurrent relationships with past year alcohol use at each assessment wave. Prospective analyses indicated that after accounting for initial levels of alcohol use, sensation seeking, and risk-taking propensity at the first assessment wave, larger increases in both constructs predicted greater odds of alcohol use at subsequent assessment waves. CONCLUSIONS Results indicate the role of individual changes in disinhibitory traits in initial alcohol use in early adolescents. Specifically, findings suggest it is not simply initial levels of sensation seeking and risk-taking propensity that contribute to subsequent alcohol use but in particular increases in each of these constructs that predict greater odds of use. Future work should continue to assess the development of sensation seeking and risk-taking propensity in early adolescence and target these constructs in interventions as a potential means to reduce adolescent alcohol use.

MEDITATIVE THERAPIES FOR REDUCING ANXIETY: A SYSTEMATIC REVIEW AND META‐ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Anxiety disorders are among the most common psychiatric disorders and meditative therapies are frequently sought by patients with anxiety as a complementary therapy. Although multiple reviews exist on the general health benefits of meditation, no review has focused on the efficacy of meditation for anxiety specifically.

Theory-Driven Intervention for Changing Personality: Expectancy Value Theory, Behavioral Activation, and Conscientiousness

Considerable evidence suggests that personality traits may be changeable, raising the possibility that personality traits most linked to health problems can be modified with intervention. A growing body of research suggests that problematic personality traits may be altered with behavioral intervention using a bottom-up approach. That is, by targeting core behaviors that underlie personality traits with the goal of engendering new, healthier patterns of behavior that, over time, become automatized and manifest in changes in personality traits. Nevertheless, a bottom-up model for changing personality traits is somewhat diffuse and requires clearer integration of theory and relevant interventions to enable real clinical application. As such, this article proposes a set of guiding principles for theory-driven modification of targeted personality traits using a bottom-up approach, focusing specifically on targeting the trait of conscientiousness using a relevant behavioral intervention, Behavioral Activation (BA), considered within the motivational framework of expectancy value theory (EVT). We conclude with a real case example of the application of BA to alter behaviors counter to conscientiousness in a substance-dependent patient, highlighting the EVT principles most relevant to the approach and the importance and viability of a theoretically driven, bottom-up approach to changing personality traits.

Examining the effect of the Life Enhancement Treatment for Substance Use (LETS ACT) on residential substance abuse treatment retention

Effective, parsimonious behavioral interventions that target reinforcement are needed for substance users with depression to improve mood as well as treatment retention. The Life Enhancement Treatment for Substance Use (LETS ACT; Daughters et al., 2008) is a behavioral activation-based approach tailored to increase levels of positive reinforcement among depressed substance users while in substance abuse treatment. The current study tested the efficacy of LETS ACT compared to a contact-time matched control condition, supportive counseling (SC), examining effects on depressed mood, substance abuse treatment retention, and behavioral activation outcomes. Fifty-eight adult substance users in residential substance abuse treatment presenting with depressive symptoms (BDI≥12) were randomly assigned to LETS ACT or SC. Assessments were administered at pre- and post-treatment and included assessment of DSM-IV psychiatric diagnoses, depression severity, treatment motivation, overall activation, environmental reward, and substance abuse treatment retention. Patients in LETS ACT had significantly higher rates of substance abuse treatment retention and significantly greater increases in activation on the Behavioral Activation for Depression Scale (BADS) compared to those in SC. Both groups had decreased depression severity at post-treatment, although the group by time interaction was not significant. This study was the first to compare LETS ACT to a contact-time matched control treatment to evaluate effects on substance abuse treatment retention and two distinct measures of behavioral activation: overall activation and environmental reward. Findings suggest preliminary support for the feasibility, tolerability, and efficacy of a brief behavioral activation-based protocol that may be particularly useful to improve substance abuse treatment retention.

The reward probability index: design and validation of a scale measuring access to environmental reward.

Behavioral models of depression implicate decreased response-contingent positive reinforcement (RCPR) as critical toward the development and maintenance of depression (Lewinsohn, 1974). Given the absence of a psychometrically sound self-report measure of RCPR, the Reward Probability Index (RPI) was developed to measure access to environmental reward and to approximate actual RCPR. In Study 1 (n=269), exploratory factor analysis supported a 20-item two-factor model (Reward Probability, Environmental Suppressors) with strong internal consistency (α=.90). In Study 2 (n=281), confirmatory factor analysis supported this two-factor structure and convergent validity was established through strong correlations between the RPI and measures of activity, avoidance, reinforcement, and depression (r=.65 to .81). Discriminant validity was supported via smaller correlations between the RPI and measures of social support and somatic anxiety (r=-.29 to -.40). Two-week test-retest reliability was strong (r=.69). In Study 3 (n=33), controlling for depression symptoms, hierarchical regression supported the incremental validity of the RPI in predicting daily diary reports of environmental reward. The RPI represents a parsimonious, reliable, and valid measure that may facilitate understanding of the etiology of depression and its relationship to overt behaviors.

Long-term survivor characteristics in HER2-positive metastatic breast cancer from registHER.

Background:Data characterising long-term survivors (LTS) with human epidermal growth factor receptor 2 (HER2)–positive metastatic breast cancer (MBC) are limited. This analysis describes LTS using registHER observational study data.Methods:A latent class modelling (LCM) approach was used to identify distinct homogenous patient groups (or classes) based on progression-free survival (PFS), overall survival, and complete response. Demographics, clinicopathologic factors, first-line treatment patterns, and clinical outcomes were described for each class. Class-associated factors were evaluated using logistic regression analysis.Results:LCM identified two survivor groups labelled as LTS (n=244) and short-term survivors (STS; n=757). Baseline characteristics were similar between groups, although LTS were more likely to be white (83.6% vs 77.8%) with oestrogen receptor–positive (ER+) or progesterone receptor–positive (PgR+) disease (59.4% vs 50.9%). Median PFS in LTS was 37.2 (95% confidence interval (CI): 32.9–40.5) vs 7.3 months (95% CI: 6.8–8.0) in STS. Factors associated with long-term survival included ER+ or PgR+ disease, metastasis to node/local sites, first-line trastuzumab use, and first-line taxane use.Conclusions:Prognostic variables identified by LCM define a HER2-positive MBC patient profile and therapies that may be associated with more favourable long-term outcomes, enabling treatment selection appropriate to the patient’s disease characteristics.

Prevalence of Psychiatric and Substance Abuse Symptomatology Among HIV-Infected Gay and Bisexual Men in HIV Primary Care

BACKGROUND The presence of psychiatric symptoms in gay/bisexual men managing HIV are underidentified and undertreated and can interfere with optimal HIV disease management. There is a paucity of prevalence reports of these symptoms in this group, identified in the primary HIV care setting. Few studies have compared prevalence rates based on empirically supported screening tools in relation to diagnoses made in primary care. OBJECTIVE The purpose of this study was to identify the prevalence of psychiatric symptoms and substance abuse in HIV-infected gay/bisexual men and to estimate the proportion of those who had been diagnosed within their primary medical care setting. METHOD Participants (n = 503) were HIV-infected gay/bisexual men screened for participation in a HIV prevention trial and completed psychosocial assessment. Data were also extracted from patients׳ electronic medical record. RESULTS More than 47% of participants met diagnostic screen-in criteria for any anxiety disorder, of whom approximately one-third were identified in primary care. More than 22% screened in for a depressive mood disorder, approximately 50% of whom had been identified in primary care. A quarter of the sample had elevated substance abuse symptoms, 19.4% of whom were identified in primary care. Of those with symptoms of alcohol abuse (19.9%), 9.0% of those were identified in primary care. CONCLUSION These results provide some evidence suggesting that mood, anxiety, and substance abuse symptomatology are prevalent among HIV-infected gay/bisexual men and are underidentified in primary care. Increased mental health and substance use screening integrated into HIV primary care treatment settings may help to identify more gay/bisexual men in need of treatment.

Gender and Social Rejection as Risk Factors for Engaging in Risky Sexual Behavior Among Crack/Cocaine Users

Crack/cocaine and engagement in risky sexual behavior represent important contributors to the escalation of the HIV infection among women. Several lines of research have emphasized the role of social factors in women’s vulnerability for such practices and stressed the importance of understanding such factors to better inform prevention efforts and improve their effectiveness and efficiency. However, few studies have attempted to pinpoint specific social/contextual factors particularly relevant to high-risk populations such as female crack/cocaine users. Extensive previous research has related the experience of social rejection to a variety of negative outcomes including, but not limited to, various forms of psychopathology, self-defeating, and self-harm behavior. Motivated by this research, the current study explored the role of laboratory-induced social rejection in moderating the relationship between gender and risky sexual behavior among a sample of crack/cocaine users (n = 211) at high risk for HIV. The results showed that among women, but not among men, experiencing social rejection was significantly associated with a greater number of sexual partners. Further, experiencing social rejection was not related to the frequency of condom use. Implications for future research, prevention, and treatment are discussed.

Rumination Mediates the Relationship Between Distress Tolerance and Depressive Symptoms Among Substance Users

Distress tolerance has been implicated in the emergence of internalizing symptomatology, notably depressive symptoms. However, few studies have tested potential mechanisms underlying the relationship between distress tolerance and depressive symptoms, and further, this has not been tested among substance users, who commonly experience both low distress tolerance and elevated depressive symptoms. The current study focused on the construct of rumination, which has been suggested to be a coping response to stress associated with substance use and depression. Two forms of rumination, brooding and reflection, were tested as potential mediators of the relationship between distress tolerance and self-reported depressive symptoms among 128 individuals entering substance abuse treatment. Brooding (i.e., to overly focus on symptoms of distress) mediated the relationship between distress tolerance and depressive symptoms. However, reflection (i.e., to attempt to gain insight into problems) was unrelated to distress tolerance. Findings suggest the important role of brooding as a mechanism underlying the relationship between distress tolerance and depressive symptomatology.