Kirsten A. Hawkins

Posttraumatic stress disorder and cannabis use in a nationally representative sample.

The present study examined the relations between posttraumatic stress disorder (PTSD) and cannabis use in a large representative survey of adults (N = 5,672) from the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (i.e., age, marital status, ethnicity, education, income, and sex), alcohol use disorders, and nicotine dependence, lifetime and current (past year) PTSD diagnoses were associated with increased odds of lifetime history of cannabis use as well as past year daily cannabis use. Lifetime, but not current, PTSD diagnosis also was uniquely associated with increased risk for any past year cannabis use. Additional analyses revealed that the relations between PTSD (lifetime and current) and lifetime cannabis use remained statistically significant when adjusting for co-occurring anxiety and mood disorders and trauma type frequency. Overall, these findings add to the emerging literature demonstrating a possibly important relationship between PTSD and cannabis use.

Anger problems across the anxiety disorders: findings from a population-based study.

Background: Previous research examining anger problems among the anxiety disorders has been limited by the use of nonrepresentative samples, univariate analyses, as well as low sample size. The current study examined the association between posttraumatic stress disorder (PTSD), panic disorder (PD), social anxiety disorder, specific phobia (SP), and generalized anxiety disorder (GAD) and anger experience and expression. We hypothesized that greater anger experience and expression would be associated with all anxiety disorders, but that it would be most consistently associated with PTSD and PD diagnoses, and that these relationships would remain significant after controlling for demographics (i.e. age, gender, ethnicity, marital status, and income) and comorbid disorders. Methods: Participants included 5,692 (54% female) adults from the National Comorbidity Survey—Replication, a large, nationally representative survey. Results: Our data suggest that there are unique relationships between multiple anxiety disorders and various indices of anger experience and expression that are not better accounted for by psychiatric comorbidity. Contrary to predictions, PTSD and PD were not consistently associated with anger experience and expression. Conclusions: Overall, these findings lend support to the emerging literature demonstrating a potentially important relationship between anxiety disorders and anger problems. Depression and Anxiety, 2011.© 2010 Wiley‐Liss, Inc.

Comorbid panic attacks among individuals with posttraumatic stress disorder: Associations with traumatic event exposure history, symptoms, and impairment

Little is known about the prevalence of panic attacks in PTSD and their influence on symptom severity and disability. Utilizing the National Comorbidity Survey-Replication data, respondents meeting DSM-IV criteria for past year PTSD (n=203) with and without comorbid panic attacks were compared across various dimensions. Past year panic attacks were found among 35% of the sample and were associated with greater PTSD-related disability and less time spent at work. Panic attacks were also associated with greater prevalence of comorbid depression, substance abuse/dependence, medically unexplained chronic pain, number of anxiety disorders and lifetime traumatic events, PTSD reexperiencing and avoidance/numbing symptoms, and treatment-seeking related to traumatic stress reactions. Multivariate analyses revealed that panic attacks were one of the only unique predictors of severe PTSD-related disability. Overall, findings suggest that panic attacks are common among individuals with PTSD; therapeutic strategies targeting panic in this population may be of significant benefit.

Effects of Interpretation Training on Hostile Attribution Bias and Reactivity to Interpersonal Insult

Research suggests that individuals high in anger have a bias for attributing hostile intentions to ambiguous situations. The current study tested whether this interpretation bias can be altered to influence anger reactivity to an interpersonal insult using a single-session cognitive bias modification program. One hundred thirty-five undergraduate students were randomized to receive positive training, negative training, or a control condition. Anger reactivity to insult was then assessed. Positive training led to significantly greater increases in positive interpretation bias relative to the negative group, though these increases were only marginally greater than the control group. Negative training led to increased negative interpretation bias relative to other groups. During the insult, participants in the positive condition reported less anger than those in the control condition. Observers rated participants in the positive condition as less irritated than those in the negative condition and more amused than the other two conditions. Though mediation of effects via bias modification was not demonstrated, among the positive condition posttraining interpretation bias was correlated with self-reported anger, suggesting that positive training reduced anger reactivity by influencing interpretation biases. Findings suggest that positive interpretation training may be a promising treatment for reducing anger. However, the current study was conducted with a non-treatment-seeking student sample; further research with a treatment-seeking sample with problematic anger is necessary.

Delineating a Relationship Between Problematic Anger and Cigarette Smoking: A Population-Based Study

BACKGROUND Research implicates a potentially important relationship between anger and smoking, though extant work suffers from a number of limitations, including the absence of controls for psychiatric comorbidity and the use of treatment-seeking samples. The current study sought to examine the unique associations between problematic anger and smoking behavior in a large representative sample. METHODS Participants included 5,692 adults from the National Comorbidity Survey-Replication, a nationally representative survey. Assessments of psychiatric diagnoses, smoking behavior, and problematic anger were administered. RESULTS Results indicated that problems of anger experience were significantly associated with past-year daily smoking, heavy smoking, and nicotine dependence. After controlling for demographics and psychiatric comorbidity, anger experience was uniquely associated with each of these outcomes. Anger experience also was uniquely associated with lifetime history of smoking cessation failure. CONCLUSIONS Overall, these population-based data suggest an important relationship between problematic anger and numerous aspects of smoking behavior.

The Effects of Nicotine on Intrusive Memories in Nonsmokers

Correlational research suggests that smoking increases risk of posttraumatic stress disorder (PTSD), though such research by nature cannot rule out third variable explanations for this relationship. The present study used an analogue trauma film design to experimentally test the effects of nicotine on the occurrence of intrusive memories. Fifty-four healthy nonsmokers were randomly assigned to ingest either a nicotine or placebo lozenge before viewing a film depicting motor vehicle accidents. Participants recorded intrusive memories immediately after the film and for a week via diary. Participants in the nicotine condition reported significantly more intrusive memories immediately after watching the film, yet no group differences emerged on intrusions or intrusion-related distress reported during the following week. Among participants low in dispositional rumination, those who had ingested a nicotine lozenge reported more intrusions in the subsequent week than those in the placebo condition. These findings provide novel experimental evidence for the role of nicotine in increasing risk of PTSD and suggest that nicotine may contribute to trauma-related rumination but not heightened reactivity to trauma cues.

Clarifying Relations Between Thought-Action Fusion, Religiosity, and Obsessive–Compulsive Symptoms Through Consideration of Intent

Conflicting findings regarding the relations between thought-action fusion (TAF), religiosity, and obsessive compulsive disorder (OCD) may be due to a lack of clarity regarding the intent associated with the negative thoughts under consideration. In Study 1, we examined the perceptions of the immorality of intentional and unwanted morally-relevant thoughts (Moral TAF) and their relations with OCD symptoms, religiosity, and obsessive beliefs in a non-clinical sample. In Study 2, we randomly assigned participants to complete one of two versions of a previously used sentence neutralization task that was varied in terms of intent. Perception of the immorality of intentional negative thoughts but not unwanted negative thoughts was associated with Protestant/Catholic affiliation and greater prayer frequency, and perception of the immorality of unwanted thoughts was consistently associated with obsessive beliefs. Neither form of Moral TAF was associated with OCD symptoms. Further, reaction to the modified non-intentional neutralization task was associated with OCD symptoms, thought-action fusion, and scrupulosity, while reaction to the original intentional task was only associated with Moral TAF. Overall, the findings suggest that individuals differ in their perceptions of intentional versus unintentional thoughts. Perceptions of intentional morally-relevant thoughts appear related to religiosity, while perceptions of unintentional thoughts are likely to be of greater relevance to our understanding of OCD.

A test of the unique and interactive roles of anger experience and expression in suicidality: findings from a population-based study.

Abstract This study examined the unique and interactive roles of anger experience and expression in suicidality (suicidal ideation, plans, and attempts) in a large, nationally representative sample. Participants included 5692 adults from the National Comorbidity Survey–Replication, a nationally representative survey. Anger experience was assessed through a continuous measure, whereas anger expression problems were determined by the presence of an intermittent explosive disorder diagnosis. Tests of unique associations revealed that for the overall sample, anger experience and expression each predicted a unique variance in all outcomes of suicidality. Among the individuals reporting lifetime suicidal ideation, anger experience and expression were uniquely related to suicide attempts. Analyses also revealed anger experience and expression to interact in the prediction of suicidal ideation, suggesting that these have independent and additive effects on risk for suicide. The findings suggest that both anger experience and expression contribute to suicidality and the progression from suicidal ideation to plans and attempts.

Guilt and Compulsive Washing: Experimental Tests of Interrelationships

Recent evidence suggests a potentially important relationship between guilt and compulsive washing. The present studies sought to clarify this relationship. In Study 1, we examined whether washing reduced guilt. Following guilt induction, 132 non-clinical participants were randomized to one of three conditions: hand-wiping, straightening of clutter, or a control task. Contrary to predictions, analyses indicated no differences between conditions in post-task guilt. Moderator analyses indicated that among those in the straightening task, higher ordering symptoms were associated with greater increases in guilt. Study 2 examined whether guilt increased washing behavior. Sixty-one non-clinical participants were randomized to either a guilt induction or neutral condition. Afterwards, participants were timed as they cleansed their hands. Individuals in the guilt induction condition washed significantly longer than those in the neutral condition. These findings suggest that hand-washing does not lead to unique reductions in guilt, but guilt may prolong hand-washing behavior. Theoretical and clinical implications are discussed.

Multiple facets of problematic anger among regular smokers: exploring associations with smoking motives and cessation difficulties.

INTRODUCTION Research has implicated problematic anger in multiple smoking outcomes, including nicotine dependence and difficulties with cessation. However, the mechanisms underlying the role of anger in smoking behavior and cessation difficulties remain unclear. The current study examined associations between different facets of anger with smoking motives, problematic symptoms during past quit attempts, reasons for quitting, and perceived barriers to cessation. METHODS Current smokers (N = 93) were administered measures assessing the relevant constructs. RESULTS After controlling for gender and negative affectivity, greater trait anger was uniquely related to more severe symptoms during past cessation attempts, perceived internal and external barriers to cessation, social influence reasons for quitting, and negative affect reduction and sensorimotor smoking motivations. CONCLUSIONS These findings add uniquely to the literature on anger and smoking and suggest anger plays a role in everyday smoking behavior. Smokers with problematic anger might benefit from treatment focused on reducing anger and improving interpersonal functioning. Reducing trait anger may help reduce problematic symptoms during quitting, making relapse less likely.