Kimberly A. Babson

Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature.

There has been growing interest in the interrelations among traumatic event exposure, posttraumatic stress disorder (PTSD), and sleep problems. A wealth of research has examined the associations among these factors and there is an emerging literature focused on how sleep problems relate to both traumatic event exposure and PTSD across time. The current review provides a detailed analysis of studies pertaining to the temporal patterning of sleep problems and traumatic event-related factors (e.g., traumatic event exposure, PTSD) and draws conclusions regarding the current state of this literature. Research coalesces to suggest (1) exposure to a traumatic event can interfere with sleep, (2) PTSD is related to the development of self-reported sleep problems, but evidence is less clear regarding objective indices of sleep, and (3) limited evidence suggests sleep problems may interfere with recovery from elevated posttraumatic stress levels. Future research now needs to focus on understanding mechanisms involved in these patterns to inform the prevention and treatment of comorbid sleep problems and PTSD.

Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users.

Abstract Objectives: Little research has investigated the demographic and symptom profile of medical cannabis users in states in the USA that have legalized cannabis use. Methods: In the present cross-sectional study, we investigated the demographic profile of 217 adults currently receiving medical cannabis, as well as differences in problematic use and perceived helpfulness in terms of (i) symptoms of psychological disorders and pain, and (ii) motives for use. Results: Findings indicated that medical cannabis users (i) use and perceive cannabis to be beneficial for multiple conditions, some for which cannabis is not specifically prescribed or allowed at the state level; and (ii) report similar rates of disordered use as compared with population estimates among regular users. Furthermore, problematic cannabis use was predicted by several symptoms of psychological disorders (e.g. depression) and a variety of use motives (e.g. coping), while cannabis was reported as particularly helpful among those with several psychological symptoms (e.g. traumatic intrusions), as well as those reporting use for social anxiety reasons. Conclusions: Results are discussed in terms of future directions for research given the current debates regarding legalization of cannabis for medical purposes and, more generally, the lack of empirical data to inform such debates.

The Emotional Stroop Task and Posttraumatic Stress Disorder: a Meta-Analysis

Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed.

A test of the effects of acute sleep deprivation on general and specific self-reported anxiety and depressive symptoms: an experimental extension.

Evidence indicates acute sleep deprivation affects negative mood states. The present study experimentally tested the effects of acute sleep deprivation on self-reported symptoms of state anxiety and depression as well as general distress among 88 physically and psychologically healthy adults. As hypothesized, the effects of acute sleep deprivation increased state anxiety and depression, as well as general distress, relative to a normal night of sleep control condition. Based on the tripartite model of anxiety and depression, these findings replicate and extend prior research by suggesting sleep deprivation among individuals without current Axis I disorders increases both state symptoms of anxiety and depression specifically, and general distress more broadly. Extending this work to clinical samples and prospectively testing mechanisms underlying these effects are important future directions in this area of research.

An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity : Theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy

Consistent with a risk reduction model of targeted prevention, the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking. Members of a high risk cohort, defined by high levels of anxiety sensitivity and current daily smoking (n=96), were randomly assigned to either (1) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or (2) a health information control condition of comparable length. Participants were followed for 6 months. Consistent with hypotheses, those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period. Limited evidence also suggested the intervention increased motivation to quit smoking. We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations.

Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD.

BACKGROUND The use of cannabis for medical purposes is proliferating in the U.S., and PTSD is an explicitly approved condition for accessing medical cannabis in 5 states. Prior research suggests that people with PTSD often use cannabis to help cope with their condition, and that doing so results in more frequent and problematic cannabis use patterns. Specific coping motivations, such as sleep improvement, among medical cannabis users, have not been examined. METHODS The present study evaluated specific coping use motivations, frequency of cannabis and alcohol use, and mental health among a convenience sample of patients (N=170) at a medical cannabis dispensary in California. RESULTS Those with high PTSD scores were more likely to use cannabis to improve sleep, and for coping reasons more generally, compared with those with low PTSD scores. Cannabis use frequency was greater among those with high PTSD scores who used for sleep promoting purposes compared with those with low PTSD scores or those who did not use for sleep promoting purposes. CONCLUSIONS Consistent with prior research, this study found increased rates of coping-oriented use of cannabis and greater frequency of cannabis use among medical users with high PTSD scores compared with low PTSD scores. In addition, sleep improvement appears to be a primary motivator for coping-oriented use. Additional research is needed to examine the health consequences of this pattern of cannabis use and whether alternative sleep promoting interventions (e.g. CBT-I) could reduce the reliance on cannabis for adequate sleep among those with PTSD.

Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence.

BACKGROUND AND OBJECTIVES The present study is the first to explore links between PTSD and cannabis use characteristics immediately prior to a cannabis quit attempt, including motives, use problems, withdrawal, and craving. METHODS Measures of PTSD diagnosis, symptom severity, and cannabis use characteristics were administered to a sample of cannabis dependent military veterans (n = 94). Hypotheses were tested with a series of analyses of variance and covariance and hierarchical multiple regressions with Bonferroni corrections. Analyses were conducted with and without adjusting for variance shared with substance use (cannabis, alcohol, tobacco) in the previous 90 days, and co-occurring mood, anxiety, and substance use diagnoses. RESULTS AND CONCLUSIONS Compared to participants without PTSD, participants with PTSD reported significantly increased: (a) use of cannabis to cope, (b) severity of cannabis withdrawal, and (c) experiences of craving related to compulsivity, emotionality, and anticipation, with findings regarding coping and craving remaining significant after adjusting for covariates. Among the total sample, PTSD symptom severity was positively associated with (a) use of cannabis to cope, (b) cannabis use problems, (c) severity of cannabis withdrawal, and (d) experiences of craving related to compulsivity and emotionality, with findings regarding withdrawal and emotion-related craving remaining significant after adjusting for covariates. Thus, links between PTSD and using cannabis to cope, severity of cannabis withdrawal, and especially craving appear robust across measures of PTSD and analytical method. SCIENTIFIC SIGNIFICANCE The results of this study provide support for models that posit a pernicious feedback loop between PTSD symptomatology and cannabis use.

Interactive Roles of Pubertal Timing and Peer Relations in Predicting Social Anxiety Symptoms Among Youth

The interaction between early maturation and problematic peer relations in relation to social anxiety symptoms was examined among 167 adolescents aged 10-17 years. Results indicated that early-maturing youth with problematic peer relations evidenced elevated social anxiety symptoms. Findings are discussed in terms of theoretical implications for adolescent social anxiety development.

An Experimental Investigation of the Effects of Acute Sleep Deprivation on Panic-Relevant Biological Challenge Responding

Prospective research indicates sleep deprivation potentiates anxiety development, yet relatively little research has examined the effects of sleep deprivation in terms of specific types of anxiety. The current study tested the association between acute sleep deprivation and panic-relevant biological challenge responding among nonclinical participants. One hundred and two participants were randomly assigned to either an experimental (acute sleep deprivation) or control (no sleep deprivation) group. The day prior to and following the experimental (sleep) manipulation, participants completed a 5-minute 10% carbon dioxide-enriched air laboratory-based biological challenge. As predicted, sleep deprivation increased anxious and fearful responding to the challenge. Findings suggest sleep deprivation may be an important factor to consider in models of panic development. There are several areas in this general domain that warrant additional investigation.

Sleep Problems and PTSD Symptoms Interact to Predict Marijuana Use Coping Motives: A Preliminary Investigation

The present study empirically tested the theory-based hypothesis that greater sleep problems and post-traumatic stress disorder (PTSD) symptom severity would both individually and multiplicatively predict higher levels of coping-motivated marijuana use. Twenty (15 women) adults (M age = 34.00 years, SD = 11.96) who had PTSD and were currently using marijuana participated. Results indicated a positive independent relation with sleep problems and a significant interaction between sleep problems and PTSD symptom severity in relation to coping-motivated marijuana use. Results also indicated nonsignificant omnibus regression models for all other marijuana use motives. The results suggest that there may be segments of the PTSD population that are more likely to use marijuana to cope by virtue of individual differences in sleep problems.