Julia D. Buckner

Attention training for generalized social anxiety disorder.

Attentional bias toward negative social cues is thought to serve an etiological and/or maintaining role in social anxiety disorder (SAD). The current study tested whether training patients to disengage from negative social cues may ameliorate social anxiety in patients (N = 36) with a primary diagnosis of generalized SAD. Patients were randomly assigned to either an attention training condition (n = 18), in which patients completed a modified dot-probe task designed to facilitate attentional disengagement from disgusted faces, or a control dot-probe task condition (n = 18). As predicted, patients in the attention training condition exhibited significantly greater reductions in social anxiety and trait anxiety, compared with patients in the control condition. At termination, 72% of patients in the active treatment condition, relative to 11% of patients in the control condition, no longer met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for SAD. At 4-month follow-up, patients in the attention training condition continued to maintain their clinical improvement, and diagnostic differences across conditions were also maintained. Results support attention-based models of anxiety and suggest that attention training is a promising alternative or complementary intervention.

Anxiety sensitivity as a prospective predictor of alcohol use disorders.

Emerging evidence suggests that elevated anxiety sensitivity (AS) is associated with substance use disorders. However, prospective evidence regarding this association is currently lacking. The primary aim of the present study was to determine whether AS is involved in the pathogenesis of substance-related psychopathology. A large, nonclinical sample of young adults (N = 404) was prospectively followed for approximately 2 years. AS (i.e., 16-item Anxiety Sensitivity Index total scores) at study entry and gender served as the primary predictor variables. Findings indicated that AS was uniquely associated with the later development of alcohol use disorder diagnoses. Data indicated that gender and AS did not act synergistically to predict alcohol use disorders. These data provide novel evidence for the unique effects of AS as a prospective risk factor in the development of alcohol-related disorders.

Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers.

Anxiety sensitivity, distress tolerance, and discomfort intolerance have been identified as important factors related to alcohol use motives and alcohol-related problems. Yet, these variables are highly correlated and little work has delineated whether these psychological vulnerability factors are differentially related to alcohol use motives and problems. To fill this gap in the existing literature, the present study evaluated whether anxiety sensitivity, distress tolerance, and discomfort intolerance were differentially related to high-risk alcohol use motives (i.e., coping and conformity motives) and alcohol use problems among 224 young adult, current drinkers (52.3% women; M(age)=21.18, SD=7.08). Results indicated that distress tolerance, but not anxiety sensitivity or discomfort intolerance, was significantly related to coping motives for alcohol use. Additionally, anxiety sensitivity, but not distress tolerance or discomfort intolerance, was significantly related to conformity motives for drinking. For both sets of analyses, the observed significant effects were evident above and beyond the variance accounted for by alcohol consumption level, smoking rate, negative affectivity, and non-criterion alcohol use motives. Additionally, discomfort intolerance and anxiety sensitivity each predicted alcohol use problems; effects were not attributable to negative affectivity, cigarettes smoked per day, or shared variance with distress tolerance. Findings are discussed in relation to the role of emotional sensitivity and intolerance in terms of the motivational bases for alcohol use and alcohol use problems among young adult drinkers.

Marijuana Effect Expectancies: Relations to Social Anxiety and Marijuana Use Problems

High social anxiety is related to marijuana problems, yet the nature of this relation remains unclear. We examined relations between marijuana effect expectancies, social anxiety, and marijuana among undergraduates (N=337). Social anxiety was related positively to Negative Expectancies and negatively to Tension Reduction Expectancies. Among socially anxious individuals, greater belief that marijuana produces Cognitive and Behavioral Impairment was associated with greater marijuana use rates. Negative Expectancies mediated the social anxiety-marijuana problems link. These data provide new insight into problematic marijuana use among this high-risk group.

Exploration of anxiety sensitivity and distress tolerance as vulnerability factors for hoarding behaviors

Background: The phenomenon of compulsive hoarding, characterized by the acquisition of and failure to discard a large number of possessions, is increasingly recognized as a significant public health burden. Despite the magnitude of the impairment associated with this condition, empirical research is still in the nascent stages and many facets of the phenomenology, underlying vulnerability and risk factors for hoarding, are as of yet unknown. Method: The overall aim of the current investigation was to examine the association between hoarding behaviors and two potential vulnerability factors—anxiety sensitivity (AS) and distress tolerance (DT). In addition, we investigated the robustness of these associations as well as the interaction between the two hypothesized risk factors. Three studies (total N=745) involving independent nonclinical samples assessed hoarding, AS, DT, and relevant covariates using a range of measures. Resutlts: Findings revealed that AS and hoarding are significantly and robustly associated with one another beyond general depressive, anxiety, and nonhoarding obsessive–compulsive symptoms. Hoarding was also found to be associated with low DT. Consistent with prediction, AS and DT interacted such that DT may play a less important role among individuals with low AS. By contrast, low DT appears to increase vulnerability to hoarding symptoms among individuals high in AS. Results are discussed with regard to future research and treatment implications. Depression and Anxiety, 2009. Published 2009 Wiley‐Liss, Inc.

A BIOPSYCHOSOCIAL MODEL OF SOCIAL ANXIETY AND SUBSTANCE USE

Emerging prospective work suggests that individuals with social anxiety disorder (SAD) may be at particular risk for developing substance use disorders (SUD). Yet, little is known about why this may be so. Most research has utilized existing theories of substance use (e.g. tension reduction‐based theories) to understand SAD–SUD relations. However, these theories do not address why individuals with social anxiety, in particular, experience such high rates of substance‐related problems. A possible explanation may lie in the nature of social anxiety itself, which is characterized not only by chronically elevated negative affective states, but by low positive affect, fear of scrutiny, and social avoidance. These aspects of social anxiety may work in concert to place these especially vulnerable individuals at risk for SUD. The current paper presents a biopsychosocial model of SAD‐SUD comorbidity that focuses on several specific facets of social anxiety that may be especially related to SUD risk. The utility of this model is evaluated via a review of the literature on the relations between SAD and substance‐related behaviors.

Randomized Controlled Trial of False Safety Behavior Elimination Therapy: A Unified Cognitive Behavioral Treatment for Anxiety Psychopathology

We tested the efficacy of a unified cognitive-behavioral therapy protocol for anxiety disorders. This group treatment protocol, termed false safety behavior elimination therapy (F-SET), is a cognitive-behavioral approach designed for use across various anxiety disorders such as panic disorder (PD), social anxiety disorder (SAD), and generalized anxiety disorder (GAD). F-SET simplifies, as well as broadens, key therapeutic elements of empirically validated treatments for anxiety disorders to allow for easier delivery to heterogeneous groups of patients with anxiety psychopathology. Patients with a primary anxiety disorder diagnosis (N=96) were randomly assigned to F-SET or a wait-list control. Data indicate that F-SET shows good efficacy and durability when delivered to mixed groups of patients with anxieties (i.e., PD, SAD, GAD) by relatively inexperienced clinicians. Findings are discussed in the context of balancing treatment efficacy and clinical utility.

Social anxiety disorder as a risk factor for alcohol use disorders: a prospective examination of parental and peer influences.

Elucidation of mechanisms underlying the high rates of alcohol use disorder (AUD) remains a pressing clinical and research concern. Despite data indicating that social anxiety disorder (SAD) may be a psychological vulnerability that increases AUD risk, no known prospective research has examined underlying mechanisms. Given the nature of SAD, social support and peer alcohol use may be implicated. The present study set out to clarify the SAD-AUD link in several ways using a prospective dataset comprised of 1803 (47% female) young adults at T1, 1431 of whom were assessed again approximately 3 years later. First, stringent criteria were used to directly test whether SAD was a risk for AUD. Second, we examined whether social support and peer alcohol use moderated the prospective SAD-AUD link. Structured diagnostic interviews were conducted to assess DSM-IV Axis I disorders, negative life events, social support, and peer alcohol use. Among men, Time 1 (T1) SAD was not significantly related to Time 2 (T2) AUD. Yet, among women, T1 SAD was related to T2 AUD. Further, T1 SAD was the only internalizing disorder to significantly predict T2 AUD after controlling for relevant variables (e.g., T1 depression, other anxiety, alcohol and marijuana use disorders). The SAD-AUD relation demonstrated directional specificity. Family cohesion and adverse family relations significantly moderated this relation. Findings highlight the important role of SAD and familial support in the onset of AUD among women.

Immediate Antecedents of Marijuana Use: An Analysis from Ecological Momentary Assessment

BACKGROUND AND OBJECTIVES Marijuana remains the most commonly used illicit substance. Marijuana craving, anxiety, and peer marijuana use are thought to play important roles in the etiology and maintenance of marijuana use. The present study aimed to identify patterns between marijuana use and these affective and situational risk factors in the natural environment. METHODS The sample consisted of 49 current marijuana users (38.8% female), 63.2% of whom evinced a current cannabis use disorder. Ecological momentary assessment was used to collect multiple daily ratings of marijuana craving, state anxiety, and peer marijuana use over two weeks. Mixed effects linear models were used to examine within- and between-day antecedents, correlates, and consequences of marijuana use. RESULTS Between-day analyses indicated that marijuana use days were associated with higher marijuana craving but lower state anxiety. Within-day analyses confirmed that marijuana craving was higher prior to marijuana use and lower following use. Anxiety was related to marijuana craving. Although anxiety was somewhat higher prior to marijuana use, it did not decrease significantly following use. The vast majority of marijuana use occurred when others were also using marijuana. LIMITATIONS The sample was comprised of college students, a group at particular risk for marijuana use and use-related problems. Future work is necessary to determine whether results generalize to other populations. CONCLUSIONS These data support the contention that marijuana craving, anxiety, and peer use play important roles in the maintenance of marijuana use.

Social anxiety disorder and marijuana use problems: the mediating role of marijuana effect expectancies.

Background: Individuals with social anxiety disorder (SAD) appear particularly vulnerable to marijuana‐related problems. Yet, mechanisms underlying this association are unclear. Methods: This study examined the role of marijuana effect expectancies in the relation between SAD and marijuana problems among 107 marijuana users (43.0% female), 26.2% of whom met Diagnostic and Statistical Manual for Mental Disorders—Fourth Edition criteria for SAD. Anxiety and mood disorders were determined during clinical interviews using the Anxiety Disorders Interview Schedule—IV‐L (ADIS‐IV). Results: Analyses (including sex, marijuana use frequency, major depressive disorder, and other anxiety disorders) suggest that SAD was the only disorder significantly associated with past 3‐month marijuana problems. Compared to those without SAD, individuals with SAD were more likely to endorse the following marijuana expectancies: cognitive/behavioral impairment and global negative expectancies. Importantly, these expectancies mediated the relations between SAD status and marijuana problems. Conclusions: These data support the contention that SAD is uniquely related to marijuana problems and provide insight into mechanisms underlying this vulnerability. Depression and Anxiety, 2009. Published 2009 Wiley‐Liss, Inc.