Matthew W. Gallagher

Expressive writing among Chinese American breast cancer survivors: A randomized controlled trial.

Objective: Despite the significant size of the Asian American population, few studies have been conducted to improve cancer survivorship in this underserved group. Research has demonstrated that expressive writing interventions confer physical and psychological benefits for a variety of populations, including Non-Hispanic White cancer survivors. The study aims to evaluate the health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors in the U.S. It was hypothesized that expressive writing would increase health-related quality of life (HRQOL). Method: Ninety-six Chinese breast cancer survivors were randomly assigned to 1 of 3 writing conditions: a self-regulation group, an emotional disclosure group, or a cancer-fact group. The self-regulation group wrote about one’s deepest feelings and coping efforts in addition to finding benefits from their cancer experience. The emotional disclosure group wrote about one’s deepest thoughts and feelings. The cancer-fact group wrote about facts relevant to their cancer experience. HRQOL was assessed by FACT-B at baseline, 1, 3, and 6-month follow-ups. Effect sizes and residual zed change models were used to compare group differences in HRQOL. Results: Contrary to expectations, the cancer-fact group reported the highest level of overall quality of life at the 6-month follow-up. The self-regulation group had higher emotional well-being compared to the emotional disclosure group. Conclusions: The study challenges the implicit assumption that psychosocial interventions validated among Non-Hispanic Whites could be directly generalized to other populations. It suggests that Asians may benefit from writing instructions facilitating more cognitive than emotional processes.

Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design☆

The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age=31.14years, SD=12.28, range 19-48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of weeklong blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showing exposures utilizing mindfulness were associated with higher overall distress levels, compared with those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed.

A Prospective Investigation of the Synergistic Effect of Change in Anxiety Sensitivity and Dysphoria on Tobacco Withdrawal

Objective: Prevailing theory and research suggests the psychological and physiological discomfort associated with tobacco withdrawal may play a formative role in the risk of cessation failure. Yet, research elucidating cognitive-affective vulnerability characteristics that contribute to increased tobacco withdrawal severity during periods of planned abstinence is highly limited. In the current study, we explored whether smokers with greater reductions of Anxiety Sensitivity (AS) and dysphoria during a smoking cessation intervention would experience less severe postquit tobacco withdrawal. Method: Specifically, the interactive effect of change (from preintervention baseline to quit day) in AS and dysphoria in relation to postquit withdrawal severity (quit day through 12 weeks postquit) was examined among treatment-seeking adult smokers enrolled in a smoking cessation trial (N = 198; 55.3% female; 86.8% Caucasian; Mage = 38.8, SD = 14.0). Results: Results indicated that the interactive effect of change in AS and dysphoria was related to linear change in postquit withdrawal symptoms. Specifically, larger reductions in AS were associated with a faster decline in the severity of withdrawal symptoms across the 12-week postquit period only for individuals with lower (but not higher) reductions in dysphoria. Additionally, the findings indicated that reducing levels of AS and dysphoria prequit is broadly related to the degree of change in postquit withdrawal symptoms. Conclusion: Collectively, these data suggest there is apt to be clinical merit to employing strategies to address AS and/or dysphoria to more effectively manage emergent withdrawal symptoms following smoking cessation treatment.

Emotion Dysregulation Explains Associations Between Anxiety Sensitivity and Hazardous Drinking and Drinking Motives Among Adult Treatment-Seeking Smokers.

Smoking and drinking frequently co-occur. For example, alcohol use is associated with smoking lapses during quit attempts. However, little is known regarding psychological factors explaining drinking among smokers. Anxiety sensitivity is a risk factor associated with hazardous drinking and drinking to cope and/or conform, although little is known about mechanisms underlying such associations. One potential explanatory factor is emotion dysregulation. The current study examined emotion dysregulation as an explanatory factor underlying Anxiety Sensitivity and 5 alcohol-related outcomes: hazardous drinking, alcohol consumption, alcohol problems, coping-oriented drinking, and drinking to conform. Participants for this study were 467 treatment-seeking adult, daily smokers (48.2% women; Mage = 36.7 years, SD = 13.6) who reported smoking an average of 16.5 cigarettes per day. Results indicate significant indirect effects of Anxiety Sensitivity on hazardous drinking via emotion dysregulation, alcohol consumption, alcohol problems, drinking to cope, and drinking to conform. Effects were medium in size. Alternative models testing indirect effects of emotion dysregulation through Anxiety Sensitivity on outcomes, and Anxiety Sensitivity through outcomes on emotion dysregulation were nonsignificant and all had small effect sizes. Follow-up tests examined the path of effects from Anxiety Sensitivity through specific emotion-dysregulation subfactors. Thus, among treatment-seeking smokers, emotion dysregulation may explain the associations of Anxiety Sensitivity with alcohol-related outcomes. This pattern of findings highlights the potential importance of interventions targeting emotion dysregulation among hazardous-drinking smokers.

Psychological Distress Among Smokers in the United States: 2008–2014

Abstract Introduction Decline in smoking in the United States has slowed over the past 25 years. Mental health problems are common among smokers, and may be an impediment to quitting and remaining abstinent. The study investigated the relationship between serious (past-30-day) psychological distress (SPD) and smoking, estimated trends in the prevalence of SPD among current, former, and never smokers in the United States from 2008 to 2014, and investigated whether heterogeneity in these trends varied by sociodemographic characteristics. Methods Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons ages 12 and over (N = 270 227). SPD and smoking in the past 30 days were examined using logistic regression models among adults 18 and older. The prevalence of SPD was examined annually among current, former, and never smokers from 2008 to 2014. Results SPD increased among smokers in the United States from 2008 to 2014. An increase in SPD was more rapid among non-daily smokers than daily smokers. The prevalence of SPD was higher among younger smokers, those with less formal education and lower annual family income and higher among current smokers than former and never smokers. The relationships between SPD and smoking were stronger among smokers with higher education levels and annual family income. Conclusions Our findings suggest an increase in SPD among smokers over time and that as smoking has declined, those with SPD are comprising a greater proportion of the remaining smokers. Results suggest that mental health must be integrated into mainstream tobacco control efforts. Implications The greater prevalence and increasing rate of Serious Psychological Distress among smokers, relative to former- and never-smokers, from 2008 to 2014 provides support that the greater mental health burden among smokers may be contributing to the slowed reduction in smoking prevalence in the United States. In addition, relationships between SPD and smoking were consistently stronger among smokers with higher levels of education and annual family income. Such results suggest the necessity of incorporating mental health treatments in tobacco use reduction efforts.

Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress

Both suicidality and alcohol use disorders are significant public health concerns among firefighters, and alcohol use is associated with increased suicide risk. In addition, firefighters endorse high rates of symptoms of depression and posttraumatic stress disorder (PTSD). Thus, the current investigation examined associations between alcohol dependence and suicide risk among a large sample of firefighters. Specifically, this study examined the indirect effects of alcohol dependence on suicidality outcomes via both depression and posttraumatic stress, using structural equation modeling. A total of 2883 male firefighters completed a self-report survey, containing measures of alcohol use, suicidality, PTSD, and depressive symptoms. Results indicated good model fit. The latent alcohol dependence variable was directly related to the latent suicide risk variable. However, when depression and posttraumatic stress latent variables were added into the model, alcohol dependence was no longer associated with suicide risk. Furthermore, alcohol dependence was indirectly related to suicide risk via latent depression and posttraumatic stress variables. Indirect effects were established after controlling for relevant covariates. Clinical implications are discussed.

Anxiety and cannabis-related problem severity among dually diagnosed outpatients: The impact of false safety behaviors

Cannabis use disorder (CUD) co-occurs with anxiety disorders at high rates. Little is known about the mechanisms linking CUD and anxiety disorders. One theoretically-driven perspective is that individuals with anxiety disorders may be more apt to use FSBs (i.e., behaviors that may be effective in decreasing anxiety in the short-term, but can maintain and even exacerbate anxiety in the long-term), which can perpetuate cannabis use despite cannabis-related problems. The present study tested whether FSB use explained the relation of anxiety symptom severity with cannabis quantity and related problems among 77 adults with CUD and comorbid anxiety disorders seeking outpatient CUD treatment. Results indicated that FSB frequency was significantly related to anxiety symptom severity and cannabis problem severity, but not cannabis quantity. Anxiety symptom severity was indirectly (via FSB frequency) related to cannabis problem severity, but not to cannabis quantity. These novel findings suggest that more frequent use of FSBs may play an important role in cannabis problem severity among individuals with CUD and anxiety disorders.

Frequency of Interpersonal Trauma Types, Avoidant Attachment, Self-Compassion, and Interpersonal Competence: A Model of Persisting Posttraumatic Symptoms

ABSTRACT Given limited knowledge about how psychosocial factors interact to modulate posttraumatic stress symptoms, this study evaluated an integrative model proposing that experiencing more interpersonal trauma types (e.g., abuse, assault, rape, etc.) leads to greater avoidant attachment and lower self-compassion, which limits the development and use of effective interpersonal skills. In turn, lower levels of self-compassion and interpersonal competence perpetuate posttraumatic symptoms. Anonymous trauma-experienced adults (n = 132) completed self-report measures in an online study hyperlinked on trauma support websites. Data were subjected to confirmatory factor analysis and structural equation modeling, which provided support for the hypothesized model. Specifically, higher frequency of interpersonal trauma types experienced was linked to higher avoidant attachment and lower self-compassion, which in turn were associated with lower interpersonal competence, which correlated with greater posttraumatic stress symptoms. Although cross-sectional data cannot address directionality of associations, this study’s findings emphasize the potential utility of future longitudinal research designed to examine possible causal relationships among these specific psychosocial factors. For example, study findings suggest that those who experience more types of interpersonal trauma and who are characterized by avoidant attachment and lower self-compassion and interpersonal competence may be the most susceptible to experiencing severe posttraumatic symptoms. However, findings also suggest that efforts to increase self-compassion and interpersonal skills may help reduce symptoms.

Transdiagnostic mechanisms of change and cognitive-behavioral treatments for PTSD

This paper reviews the current status of transdiagnostic mechanisms of change targeted in cognitive-behavioral interventions, with a focus on mechanisms that are also relevant to emotional disorders that frequently co-occur with PTSD. First, an overview of the rationale for and key features of identifying mechanisms of change is presented, with a discussion of why it is crucial to examine mechanisms that are relevant across diagnostic boundaries. A review of the current evidence for five promising transdiagnostic mechanisms (hope, neuroticism, emotion regulation, cognitive reappraisal, and anxiety sensitivity) is then provided. Finally, the implications of the increasing evidence of transdiagnostic mechanisms of change are discussed in relation to recently developed transdiagnostic treatment protocols that provide an alternative treatment approach for PTSD.

A Randomized Controlled Trial for Veterans with PTSD and Substance Use Disorder: Creating Change versus Seeking Safety

ABSTRACT Background: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations. Objective: To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present. Methods: Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions. Results: Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe—predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action.