Mathew G. Fetzner

What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample

Background: Approximately 60–90% of the general population will experience a traumatic event during their lifetime. However, relatively few will develop a trauma‐related psychological disorder. Possible psychological sequelae of trauma include posttraumatic stress disorder (PTSD) and alcohol‐use disorders (AUDs). While AUDs often occur in the context of PTSD, little is known about the degree to which AUDs are attributable to specific traumatic events. The purpose of the present investigation was to assess the degree to which specific traumatic events are predictive of AUDs in people with and without PTSD. Methods: The current sample was selected from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC; N = 34,160), a nationally representative sample of American adults. Multiple logistic regressions were performed to examine odds ratios of 27 traumatic events among individuals with and without PTSD in the prediction of AUD diagnoses. Results: Results indicated significant positive odds ratios among individuals meeting criteria for PTSD and having experienced a childhood trauma (OR = 1.40 [95% CI: 1.08–1.83], P<.01) or assaultive violence (OR = 1.41 [95% CI: 1.13–1.77], P<.01) for predicting AUDs. Also, among individuals without PTSD, childhood trauma (OR = 1.32 [95% CI: 1.23–1.41], P<.001), assaultive violence (OR = 1.42 [95% CI: 1.13–1.78], P<.001), unexpected death (OR = 1.19 [95% CI: 1.12–1.28], P<.001), and learning of trauma (OR = 1.22 [95% CI: 1.13–1.30], P<.001) positively predicted the presence of AUDs. Conclusions: Results indicate significant positive relationships between traumatic events and AUDs, particularly among individuals without PTSD. Specific associations and theoretical implications will be discussed. Depression and Anxiety, 2011.

Aerobic Exercise Reduces Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial

Evidence suggests aerobic exercise has anxiolytic effects; yet, the treatment potential for posttraumatic stress disorder (PTSD) and responsible anxiolytic mechanisms have received little attention. Emerging evidence indicates that attentional focus during exercise may dictate the extent of therapeutic benefit. Whether benefits are a function of attentional focus toward or away from somatic arousal during exercise remains untested. Thirty-three PTSD-affected participants completed two weeks of stationary biking aerobic exercise (six sessions). To assess the effect of attentional focus, participants were randomized into three exercise groups: group 1 (attention to somatic arousal) received prompts directing their attention to the interoceptive effects of exercise, group 2 (distraction from somatic arousal) watched a nature documentary, and group 3 exercised with no distractions or interoceptive prompts. Hierarchal linear modeling showed all groups reported reduced PTSD and anxiety sensitivity (AS; i.e., fear of arousal-related somatic sensations) during treatment. Interaction effects between group and time were found for PTSD hyperarousal and AS physical and social scores, wherein group 1, receiving interoceptive prompts, experienced significantly less symptom reduction than other groups. Most participants (89%) reported clinically significant reductions in PTSD severity after the two-week intervention. Findings suggest, regardless of attentional focus, aerobic exercise reduces PTSD symptoms.

Intolerance of Uncertainty as a Contributor to Fear and Avoidance Symptoms of Panic Attacks

Panic disorder symptoms are persistent for 50–80% of cases even after treatment, resulting in experiences of disability and dissatisfaction in life. Previous research has focused on anxiety sensitivity (AS) and its dimensions as contributing to symptoms of panic disorder; however, recent research has suggested that intolerance of uncertainty (IU)—the tendency for a person to consider the possibility of a negative event occurring as threatening, irrespective of the actual probability of its occurrence—may also play a critical role. The current study was designed to assess the specific relationships between dimensions of IU (i.e. prospective IU and inhibitory IU) and the fear and avoidance symptoms associated with panic disorder. Participants included 122 community members (81% women) with a history of at least one panic attack who participated in a larger study on fear. Participants completed measures of AS, IU, and panic disorder symptoms. Correlation and regression analyses supported a significant and substantial relationship between AS, inhibitory IU, and panic disorder symptoms. Inhibitory IU accounted for relatively more variance in avoidance symptoms related to panic disorder than did the fears of physical sensations dimension of AS. As such, further investigation of the role of IU in panic disorder symptoms appears warranted. Comprehensive results, implications, and directions for future research are discussed.

Revisiting the latent structure of the anxiety sensitivity construct: more evidence of dimensionality.

Anxiety sensitivity (AS) was initially conceptualized as existing along a continuum; however, emerging evidence from taxometric analyses is mixed as to whether the latent structure of AS is dimensional or taxonic. The purpose of the present study was to further evaluate the latent structure of AS in an effort to clarify the contrasting findings reported in the literature. To do so, we examined the latent structure of AS in two large independent samples unselected with regard to AS level (comprising undergraduate respondents and/or community residents). MAXEIG and MAMBAC analyses were performed with indicator sets drawn from distinct self-report measures of AS within either sample. MAXEIG and MAMBAC, as well as comparison analyses utilizing simulated taxonic and dimensional datasets, yielded converging evidence that AS has a dimensional latent structure. Implications of these finding for the conceptualization and measurement of AS are discussed and future research directions are highlighted.

Clarifying the Relationship Between AS Dimensions and PTSD Symptom Clusters: Are Negative and Positive Affectivity Theoretically Relevant Constructs?

The association between anxiety sensitivity (AS) and posttraumatic stress disorder (PTSD) has been established in contemporary literature; however, research is divided over the nature of specific relationships between AS dimensions and PTSD symptoms clusters. Further, a paucity of research has examined the AS and PTSD relationship while accounting for theoretically relevant variables, such as negative (NA) and positive affect (PA). The purpose of the current study was twofold: first, to clarify divergent findings regarding the contribution of AS dimensions to PTSD symptom clusters, and, second, to further assess the relevance of NA and PA within the AS/PTSD relationship. Hierarchal regression analyses showed that, beyond shared variance attributable to NA and PA, AS somatic concerns were significantly associated with three of four PTSD symptom (i.e., reexperiencing, numbing, hyperarousal), AS cognitive concerns were only associated with hyperarousal, and AS socially observable symptoms were not significantly associated with any PTSD symptom clusters. These findings suggest that AS somatic concerns are the most robust predictor of variance within the AS/PTSD relationship and further clarify the theoretical importance of NA and PA within this relationship. Comprehensive results, implication, and directions for future research are discussed.

How Do Elements of a Reduced Capacity to Withstand Uncertainty Relate to the Severity of Health Anxiety

Intolerance of uncertainty (IU)—a multidimensional cognitive vulnerability factor—is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive–compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.

Fear of Injury Predicts Self-Reported and Behavioral Impairment in Patients With Chronic Low Back Pain

UNLABELLED Fear of injury has been posited as crucial in pain-related anxiety and in the development of chronic pain; however, research has only measured fear of injury indirectly through other constructs (eg, fear of illness and fear of movement). The current study tested fear of injury as an independent contributor to pain-related anxiety and impairment. Patients (n = 78; 37% women) in a work-hardening treatment program for chronic low back pain completed self-report measures of pain-related anxiety, anxiety sensitivity, fear of injury, current pain, and impairment. Behavioral measures of impairment included lifting capacity, treatment outcomes, and days absent from treatment. Structural equation modeling tested the role of fear of injury within contemporary theory. Fit for the theoretical model was excellent and superior to an alternative model. Variance accounted for in pain-related anxiety by fear of injury, anxiety sensitivity, and current pain was 64%, while pain-related anxiety and current pain predicted 49% of variance in latent impairment. Fear of injury directly predicted pain-related anxiety (β = .42) and indirectly predicted impairment through pain-related anxiety (β = .19). Fear of injury may warrant theoretical and clinical consideration as an important contributor to pain-related anxiety and impairment; however, research is needed to explore how it may be causally related with other constructs. PERSPECTIVE Fear of injury directly predicts pain-related anxiety and indirectly predicts self-reported and behavioral impairment. Fear of injury may warrant inclusion in contemporary theories of chronic pain. Clinicians may benefit from considering the construct in interventions for chronic pain.

Symptoms of Posttraumatic Stress Disorder and Depression in Relation to Alcohol-Use and Alcohol-Related Problems among Canadian Forces Veterans:

Objective: Alcohol misuse is common among military veterans affected by posttraumatic stress disorder (PTSD) and depression; however, research to date has provided mixed evidence concerning differential associations among PTSD and depressive symptoms in relation to alcohol misuse. Further, most available studies have examined primarily male samples or have dichotomously grouped participants as either having or not having an alcohol use disorder. Our study sought to explore relations among 2 aspects of alcohol misuse (that is, alcohol-related problems, and quantity or frequency of alcohol use) and symptoms of PTSD and depression in independent samples of female and male military veterans. Method: Canadian military veterans (1271 men and 72 women) completed a battery of self-report questionnaires as part of a broader health status assessment conducted by Veterans Affairs Canada. Results: Linear regression analyses suggested depressive symptoms accounted for unique variance in reported alcohol-related problems and quantity or frequency of alcohol use among male veterans. Additionally, PTSD hyperarousal symptoms accounted for unique variance in reported alcohol-related problems. In contrast, among female veterans neither PTSD nor depressive symptoms were found to account for significant variance in measures of alcohol-related problems or quantity or frequency of alcohol use. Conclusions: Findings suggest differing mechanisms are involved in influencing alcohol misuse among male and female veterans. Accordingly, female veterans may benefit from specialized assessment and intervention approaches to prevent and treat alcohol-related disorders, rather than applying the same strategies commonly used with male veterans. Comprehensive results, implications, and directions for future research are discussed.

Similarities in specific physical health disorder prevalence among formerly deployed Canadian forces veterans with full and subsyndromal PTSD.

The link between posttraumatic stress disorder (PTSD) and deleterious physical health consequences among previously deployed military veterans has been well documented. Research has focused primarily on investigating prevalence rates of physical health disorders among individuals with PTSD. Far less research has compared prevalence rates of specific physical health disorders among individuals with full and subsyndromal PTSD. The current study investigated differences in the prevalence of seven specific categories of physical health disorders (i.e. musculoskeletal, circulatory, endocrine, respiratory, gastrointestinal, neurological, and other physical health disorders) among individuals with full PTSD, subsyndromal PTSD, and no PTSD (i.e. controls).

“It’s not just about being judged”: Interpersonal distrust uniquely contributes to social anxiety

Fears of evaluation are central to defining social anxiety disorder (SAD); notwithstanding, evidence suggests that interpersonal distrust and perceived ineffectiveness are distinct constructs, prevalent among individuals with SAD. To date, no studies have assessed the independent contributions of interpersonal distrust and perceived ineffectiveness to SAD severity beyond fears of evaluation. In total 151 community-dwelling adults (80% women) with anxiety histories completed questionnaires as part of a larger study. Hierarchal regression analyses indicated that interpersonal distrust, but not perceived ineffectiveness, contributed significant amounts of variance to SAD severity after partitioning out variance from depressive symptoms and fear of negative and positive evaluation. Concertedly, findings suggest that although fears of evaluation are seminal to SAD severity, distrust of others may also uniquely exacerbate symptoms of social anxiety. Clinical and research implications are discussed herein.