Joseph W. Boffa

Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event

Intolerance of uncertainty (IU) has been associated with elevated post-traumatic stress symptoms (PTSS) in the extant literature. However, no research to date has investigated whether pre-trauma IU predicts PTSS following trauma exposure. The current study prospectively examined the relationship between IU and PTSS within a sample of individuals with various levels of exposure to a university campus shooting. We hypothesized that pre-trauma IU would predict elevated PTSS following a campus shooting, even after covarying for anxiety sensitivity (AS), a known correlate of PTSS. Participants included undergraduates (n=77) who completed a self-report battery in Introductory Psychology. After a campus shooting, they were invited to complete measures of PTSD symptoms and level of exposure to the shooting. As anticipated, results revealed pre-trauma IU as a significant predictor of elevated PTSS following the campus shooting. These results remained significant after covarying for pre-trauma levels of AS. Our results are the first to demonstrate that elevated pre-trauma levels of IU predict later PTSS following exposure to a traumatic event. This finding is discussed in terms of promising directions for future research and treatment strategies.

Validation of the Cyberchondria Severity Scale (CSS): Replication and extension with bifactor modeling

Internet help seeking behaviors are increasingly common. Despite the positives associated with technology, cyberchondria, or the process of increased anxiety in response to internet medical information seeking, is on the rise. The Cyberchondria Severity Scale (CSS) was recently developed to provide a valid measure of cyberchondria across multiple dimensions. The current study sought to extend previous work on the CSS factor structure by examining a bifactor model. Participants (N=526) from a community sample completed the CSS via online crowd sourcing. Results revealed that the bifactor model of the CSS provided superior fit to the data, suggesting that it is useful to conceptualize the CSS as containing a General Cyberchondria factor that is orthogonal to its subfactors. Similar to previous work, the CSS Mistrust factor does not appear to be necessary to this construct. Finally, results revealed unique relations between General and Specific Cyberchondria factors with lower-order health anxiety dimensions.

Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters

Firefighters are at increased risk for mental health problems. However, little is known about differences in psychiatric symptoms between volunteer and career firefighters. This study aimed to (1) describe differences in psychiatric symptoms and barriers to mental health care between U.S. firefighters in volunteer-only and career-only departments; and (2) determine if greater self-reported structural barriers to mental health care (e.g., cost, availability of resources) explain the differences in psychiatric symptom levels. Overall, 525 current U.S. firefighters participated. Analyses of covariance and logistic regression analyses were used to evaluate group differences between volunteer (n=204) and career (n=321) firefighters, adjusting for demographic and occupational characteristics. Volunteer firefighters reported significantly elevated levels of depression, posttraumatic stress, and suicidal symptoms compared to career firefighters. Career firefighters reported relatively elevated levels of problematic alcohol use. Volunteer firefighters additionally reported greater structural barriers to mental health care (e.g., cost, availability of resources), and these barriers accounted for the differences in mental health variables between volunteer and career firefighters. Findings suggest that volunteer firefighters report elevated psychiatric symptoms compared to career firefighters and greater structural barriers to mental health treatment may explain this link. Increased efforts are needed to develop firefighter-specific interventions and bolster mental health service utilization.

Anxiety Sensitivity Prospectively Predicts Posttraumatic Stress Symptoms Following a Campus Shooting.

Anxiety sensitivity (AS), the feared consequences of anxious arousal, is known to be related to posttraumatic stress symptoms (PTSS) concurrently and longitudinally. However, no studies have demonstrated whether AS prior to a Criterion A traumatic event predicts later PTSS. The present study evaluated whether preshooting AS predicted PTSS following a campus shooting, as well as whether preshooting AS interacted with shooting exposure to predict PTSS. Participants comprised undergraduates (N=71) who completed a self-report battery upon enrolling in Introductory Psychology. After a campus shooting later in the semester, they were invited to complete measures of PTSS and level of exposure to the shooting. Preshooting levels of AS significantly predicted PTSS after the shooting. This effect was qualified by a significant AS by shooting exposure interaction, such that those with high AS who were exposed to the shooting reported the greatest levels of PTSS. Though all three of the preshooting physical, cognitive, and social AS subfactors demonstrated main effects significantly predicting postshooting PTSS, only AS physical concerns significantly interacted with shooting exposure. The implications of this study concerning AS as a causal risk factor for PTSD are discussed.

Hoarding and eating pathology: The mediating role of emotion regulation

Hoarding disorder is characterized by persistent difficulty discarding possessions resulting in clutter that precludes one from using living areas for their intended purposes. The limited empirical work available has suggested a strong link between hoarding and various non-psychiatric conditions, including obesity. Despite these associations, no research has examined the link between hoarding and other forms of eating pathology including symptoms associated with binge eating. Moreover, little is known about mechanisms that may account for this relationship. The current study examined the associations between hoarding severity, obesity, and symptoms associated with binge eating in a sample (N=97) of individuals with elevated hoarding symptoms. Results revealed that hoarding severity was associated with increased body mass index (BMI) and symptoms of binge eating. In addition, difficulties regulating emotions mediated the association between hoarding and eating concerns. Considering the lack of information on hoarding behaviors, as well as its classification as a new diagnosis within DSM-5, these findings add considerably to a growing body of literature on hoarding disorder.

Gender Difference in Attentional Bias Toward Negative and Positive Stimuli in Generalized Anxiety Disorder

Females are two times as likely as males to develop generalized anxiety disorder (GAD; Steiner et al., 2005; Vesga-López et al., 2008). Moreover, the clinical presentation of GAD is different across genders. One explanation for these differences may be the role of cognitive biases involved in GAD between genders. In the present study, we used an exogenous spatial cueing task to examine gender differences in attentional bias for negative and positive information in 118 individuals with a primary diagnosis of GAD. Males and females did not differ in their attentional bias for idiographically selected negative or neutral words. However, women showed a significantly larger attentional bias for positive words than did men. Results suggest that developing gender-specific treatments for GAD could improve treatment response rates.

Anxiety sensitivity mediates gender differences in post-concussive symptoms in a clinical sample

Traumatic brain injury (TBI) is both prevalent and potentially disabling. Extant literature has demonstrated women to report greater post-concussive symptoms (PCS) compared to men, highlighting the necessity of investigations into malleable, gender-linked risk factors for PCS that hold promise for reducing this gender disparity. Anxiety Sensitivity (AS) and Distress Tolerance (DT) are gender-linked risk factors that may be related to PCS. Despite a breadth of research supporting elevated AS and reduced DT in women, no study to date has investigated whether AS and DT mediate gender differences in PCS. The current sample was composed of 59 participants selected from a larger study based on their report of a past TBI. Findings indicated that AS, but not DT, significantly mediated gender differences in PCS. The present results suggest that AS is a cognitive risk factor that can partially account for the gender disparity in the expression of PCS. AS may influence an individuals interpretation of PCS as dangerous, thereby amplifying the perception of PCS severity. This suggests that efforts to reduce the burden of TBI may benefit from targeting AS in prevention and treatment paradigms, especially among women.

The mediating role of sleep disturbances in the relationship between posttraumatic stress disorder and self-injurious behavior.

Although posttraumatic stress disorder (PTSD) is associated with self-injurious behavior, it is currently unclear what mechanisms may account for this relationship. Sleep disturbances may be relevant as they are common among those with PTSD and are associated with emotion regulation difficulties, which may increase vulnerability to self-injurious behavior. As such, we investigated the relationship between PTSD and self-injurious behaviors, and the mediating roles of nightmares and insomnia. Hypotheses were tested cross-sectionally in a sample of psychology clinic outpatients (N=255). Participants completed a structured clinical interview assessing PTSD and self-report questionnaires measuring insomnia, nightmares, and self-injurious behaviors (i.e., Have you ever cut, burned, or scratched yourself on purpose?). PTSD was associated with self-injurious behavior after covarying for depression, and nightmare severity mediated the relationship between PTSD and self-injurious behavior. Findings are consistent with research indicating that sleep disturbances, specifically nightmares, are important predictors of poor outcomes among those with PTSD, and extend this research to suggest their role in self-injurious behaviors as well.

Investigating the role of hopelessness in the relationship between PTSD symptom change and suicidality

BACKGROUND This study served as an initial investigation of the role hopelessness may play in the relationship between PTSD symptom change and suicide intent, among a trauma-exposed, treatment-seeking sample. We explored whether the effect of PTSD symptom change on self-reported likelihood of a future suicide attempt (FSA) varies as a function of pre-treatment hopelessness, and whether reductions in hopelessness serve as a mechanism through which PTSD symptom change influences FSA likelihood. METHODS Data was collected from participants (N = 159) in a larger randomized clinical trial of a suicide risk-factor intervention. Self-report questionnaires assessed hopelessness, PTSD symptoms, depression symptoms, and FSA likelihood at pre-treatment and one-month follow-up. RESULTS Pre-treatment hopelessness emerged as a significant moderator, such that overall PTSD symptom reductions were related to overall decreases in FSA likelihood among those at or above (but not those below) the sample mean of pre-treatment hopelessness. In a subsample of individuals who reported FSA likelihood > 0 and elevated hopelessness at pre-treatment, overall pre-treatment-to-month-one reductions in hopelessness significantly mediated the relationship between overall PTSD symptom reductions and decreased FSA likelihood during this same time period, even after accounting for depression symptom changes. LIMITATIONS Data were limited to self-report measures (i.e., hopelessness, FSA likelihood). The intervention was not PTSD-specific. Mediation analyses were strictly statistical due to overlapping time-points. CONCLUSIONS This preliminary investigation suggests pre-treatment hopelessness may serve to identify trauma-exposed individuals for whom PTSD treatment would significantly reduce FSA likelihood. Moreover, reductions in FSA likelihood during treatment may be due in part to reduced hopelessness.

Occupational stress and suicidality among firefighters: Examining the buffering role of distress tolerance

Past research indicates that firefighters are at increased risk for suicide. Firefighter-specific occupational stress may contribute to elevated suicidality. Among a large sample of firefighters, this study examined if occupational stress is associated with multiple indicators of suicide risk, and whether distress tolerance, the perceived and/or actual ability to endure negative emotional or physical states, attenuates these associations. A total of 831 firefighters participated (mean [SD] age = 38.37y[8.53y]; 94.5% male; 75.2% White). The Sources of Occupational Stress-14 (SOOS-14), Distress Tolerance Scale (DTS), and Suicidal Behaviors Questionnaire-Revised (SBQ-R) were utilized to examine firefighter-specific occupational stress, distress tolerance, and suicidality, respectively. Consistent with predictions, occupational stress interacted with distress tolerance, such that the effects of occupational stress on suicide risk, broadly, as well as lifetime suicide threats and current suicidal intent, specifically, were attenuated at high levels of distress tolerance. Distress tolerance may buffer the effects of occupational stress on suicidality among firefighters. Pending replication, findings suggest that distress tolerance may be a viable target for suicide prevention initiatives within the fire service.