Matthew T. Feldner

Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge

The present study examined the affective consequences of response inhibition during a state of anxiety-related physical stress. Forty-eight non-clinical participants were selected on the basis of pre-experimental differences in emotional avoidance (high versus low) and subjected to four inhalations of 20% carbon dioxide-enriched air. Half of the participants were instructed to inhibit the challenge-induced aversive emotional state, whereas the other half was instructed to simply observe their emotional response. Participants high in emotional avoidance compared to those low in emotional avoidance responded with greater levels of anxiety and affective distress but not physiological arousal. Individuals high in emotional avoidance also reported greater levels of anxiety relative to the low emotional avoidance group when suppressing compared to observing bodily sensations. These findings are discussed in terms of the significance of emotional avoidance processes during physical stress, with implications for better understanding the nature of panic disorder.

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.

A Critical Analysis of Approaches to Targeted PTSD Prevention Current Status and Theoretically Derived Future Directions

Although efforts to prevent posttraumatic stress disorder (PTSD) have met with relatively limited success, theoretically driven preventive approaches with promising efficacy are emerging. The current article critically reviews investigations of PTSD prevention programs that target persons at risk for being exposed to a traumatic event or who have been exposed to a traumatic event. This review uniquely extends prior reviews in this area by using theories of PTSD to suggest future directions in the area of PTSD prevention. The authors first discuss the primary mechanisms of action believed to account for the failure for PTSD symptoms to remit among a substantial minority of traumatic event-exposed individuals. Second, empirical progress in PTSD prevention efforts is reviewed. Third, the authors consider how existing prevention programs target these mechanisms of action. Finally, the authors consider directions for future research in the area of targeted PTSD prevention.

Affective style among smokers: Understanding anxiety sensitivity, emotional reactivity, and distress tolerance using biological challenge

The present investigation evaluated affective style in terms of anxiety sensitivity, emotional reactivity, and distress tolerance in heavy smokers. Specifically, heavy smokers (> or = 20 cigarettes per day) were partitioned into those who were able to quit for at least 7 days (n = 10) and those who were able to quit for less than 7 days (n = 12). All participants completed measures of anxiety sensitivity and maximum breath-holding duration and then were exposed to a 20% carbon dioxide-enriched air challenge. Results indicated that heavy smokers who had not been able to remain abstinent from smoking for at least 1 week during a quit attempt demonstrated significantly greater cognitive-affective reactivity to the challenge relative to their counterparts but did not differ at a physiological level of analysis. Contrary to our hypotheses, neither anxiety sensitivity scores nor maximum breath-holding duration significantly differed between the groups. These findings are discussed in relation to better understanding affective style among heavy smokers.

Avoidance-oriented coping as a predictor of panic-related distress: a test using biological challenge

The present experimental psychopathology study sought to investigate the extent to which pre-experimental levels of avoidance-oriented coping predict anxious and fearful responding during acute physical stress, relative to other theoretically relevant variables. Participants included 80 individuals with no known history of psychological or physical health problems. Dependent measures include self-reported anxiety, DSM-IV panic symptoms, and physiological indices of heart rate and skin conductance. Consistent with our hypotheses, the tendency to engage in avoidance-oriented coping predicted increased physical panic symptoms and self-reported anxiety elicited by biological challenge, relative to specific anxiety sensitivity (AS) dimensions. These findings are discussed in terms of how specific types of coping are associated with prototypical indices of panic distress, with implications for forwarding future work on emotional regulation in panic disorder.

Evaluating differential predictions of emotional reactivity during repeated 20% carbon dioxide-enriched air challenge

The present study explored psychological predictors of response to a series of three 25 second inhalations of 20% carbon dioxide-enriched air in 60 nonclinical participants. Multiple regression analyses indicated that only anxiety sensitivity physical concerns predicted self-reported fear, whereas both physical anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted affective ratings of emotional arousal. In contrast, the psychological concerns anxiety sensitivity dimension predicted ratings of emotional displeasure (valence), and both psychological anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted emotional dyscontrol. No variables significantly predicted heart rate. These data are in accord with current models of emotional reactivity that highlight the role of cognitive variables in the production of anxious and fearful responding to somatic perturbation, and help further clarify the particular predictors of anxiety-related responding to biological challenge.

Offspring psychological and biological correlates of parental posttraumatic stress: review of the literature and research agenda.

Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.

Impact of Posttraumatic Stress Disorder on Early Smoking Lapse and Relapse During a Self-Guided Quit Attempt Among Community-Recruited Daily Smokers

The present investigation examined whether daily smokers with posttraumatic stress disorder (PTSD), as compared to daily smokers with either anxiety psychopathology or no current Axis I psychopathology, have decreased success in the early phases of a self-guided smoking quit attempt. Participants were 140 daily smokers (81 women; M (age) = 29.5; SD = 11.9; range = 18-65 years); approximately one-third of the sample met criteria for current PTSD (n = 47), one-third met criteria for other current anxiety disorders (without PTSD; n = 33), and one-third did not meet criteria for any current Axis I disorder (n = 60). Consistent with prediction, membership in the PTSD group, compared to membership in the other anxiety disorders group and the group with no current Axis I psychopathology, was associated with increased risk of lapse during the first week following quit day. Additionally, daily smokers with PTSD and other anxiety disorders were at significantly increased risk of relapse during the first week post-cessation compared to persons without Axis I psychopathology. However, the PTSD group and the other anxiety disorders group did not differ from one another in terms of relapse. Results suggest that PTSD is associated with increased risk of smoking lapse and relapse compared to smokers with no current Axis I psychiatric problems, and increased risk of early smoking lapse but not relapse, as compared to those with other anxiety disorders. Findings provide novel evidence that PTSD, and perhaps anxiety disorders more generally, may be important factors in reducing the odds of successful unaided quit attempts in the early phases of cessation.

Anxiety sensitivity: association with intensity of retrospectively‐rated smoking‐related withdrawal symptoms and motivation to quit

The present cross‐sectional study evaluated the associations between anxiety sensitivity, intensity of retrospectively‐rated nicotine withdrawal symptoms, and motivation to quit smoking. Participants were 127 young adult (mean age 20.4 years (SD 4.6)) regular smokers (mean cigarettes per day 10.2 (SD 5.1)). Anxiety sensitivity predicted intensity of retrospectively rated withdrawal symptoms during the first week of the most recent quit attempt as well as concurrent and lifetime indices of motivation to quit smoking even after controlling for theoretically‐relevant smoking (e.g. nicotine dependence) and affect (e.g. panic attack history) factors. These results are discussed in relation to better understanding panic‐related vulnerability factors in smoking cessation.

Evaluating the Role of Anxiety Sensitivity in Smoking Outcome Expectancies Among Regular Smokers

The present study evaluated the association between the lower-order facets of anxiety sensitivity construct (physical, mental incapacitation, and social concerns) and positive (expectancies about negative affect reduction) and negative (expectancies about negative personal consequences) smoking outcome expectancies. Participants were 90 young adult regular smokers [37 females; Mage = 23.4 years (SD = 8.9); mean number of cigarettes/day = 11.7 (SD = 6.1)] with no history of psychopathology or nonclinical panic attacks recruited from the general population. Anxiety sensitivity physical concerns and mental incapacitation concerns, as indexed by the Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. Gursky, & R. J. McNally, 1986), were significantly and incrementally associated with smoking outcome expectancies, as indexed by the Smoking Consequences Questionnaire (SCQ; T. H. Brandon & T. B. Baker, 1991), for negative affect reduction as well as negative personal consequences; the observed effects were over and above the variance accounted for by theoretically relevant smoking history characteristics, gender, and negative affectivity. Results are discussed in relation to better understanding motivational processes for smoking among groups at heightened risk for developing panic psychopathology.