Melissa A. Mitchell

Anxiety Symptomatology: The Association With Distress Tolerance and Anxiety Sensitivity

Research focused on psychological risk factors for anxiety psychopathology has led to better conceptualization of these conditions as well as pointed toward preventative interventions. Anxiety sensitivity (AS) has been well-established as an anxiety risk factor, while distress tolerance (DT) is a related construct that has received little empirical exploration within the anxiety psychopathology literature. The current investigation sought to extend the existing literature by examining both DT and the relationship between DT and AS across a number of anxiety symptom dimensions, including panic, generalized anxiety, social anxiety, and obsessive-compulsive anxiety. Participants (N=418) completed a number of measures that assessed DT, AS, anxiety symptomatology, and negative affect. Findings indicated that DT was uniquely associated with panic, obsessive compulsive, general worry, and social anxiety symptoms, but that DT and AS were not synergistically associated with each of these symptom dimensions. These findings indicate that an inability to tolerate emotional distress is associated with an increased vulnerability to experience certain anxiety symptoms.

Anxiety sensitivity: prospective prediction of anxiety among early adolescents.

Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks as well as clinical syndromes in adult samples. The primary aim of the present study was to determine whether AS similarly acts as a vulnerability factor in the pathogenesis of anxiety symptoms among youth in early adolescence (ages 9-13). A large nonclinical community sample of youth (n=277) was prospectively followed over 1 year. The Childhood Anxiety Sensitivity Index (CASI: Silverman, Fleisig, Rabian, & Peterson, 1991) served as the primary predictor. After controlling for baseline anxiety symptoms as well as depression, AS significantly predicted the future development of anxiety symptoms. Consistent with the adult literature and expectancy theory, AS appears to act as a risk factor for anxiety symptoms in youth.

Smoking cessation behavior in older adults by race and gender: the role of health problems and psychological distress.

INTRODUCTION Initial research on older smokers suggests that a subgroup of smokers with higher levels of psychological distress and health problems may be more likely to quit smoking than older smokers with fewer such problems. The present study, based on prospective data from a biracial sample of older adults (N = 4,162), examined characteristics of older adult smokers by race and gender. METHODS The present study uses both cross-sectional and prospective data to examine the association between smoking behavior, smoking cessation, health functioning, and psychological distress in a biracial sample of community-dwelling older adults. RESULTS We found baseline psychological distress to be associated with poor health functioning. Consistent with hypotheses, baseline (Time 1) psychological distress predicted smoking cessation 3 years later (Time 2). Moreover, the change in health problems between Time 1 and Time 2 fully mediated the association between Time 1 distress and smoking cessation. DISCUSSION Smoking cessation behavior of older adults is best explained by higher levels of distress and health problems regardless of race or gender. These findings may have important treatment implications regarding smoking cessation programs among older adults. Older adult smokers with higher levels of psychological distress and health problems may be more motivated to quit smoking than those with fewer such problems. These difficulties should be targeted within the context of the smoking cessation protocol. Also, we identified a subgroup of older smokers who are reporting fairly good health and lower levels of distress and who are less likely to quit smoking. Motivational methods may need to be developed to engage this group in smoking cessation treatment.

Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: a comparison of three models.

Emerging work has identified several related constructs that appear to be relevant to anxiety psychopathology including anxiety sensitivity (AS), distress tolerance (DT) and discomfort intolerance (DI). AS refers to the fear of the consequences of anxiety-related sensations. DT measures tolerance of negative emotions, whereas DI measures tolerance of uncomfortable physical sensations. Questions, however, have been raised regarding the overlap among AS, DT, and DI. The present study conducted confirmatory factor analyses to test three models of emotional and physical tolerance to determine which model provided the best fit for the associations among AS, DT, and DI. Nonclinical individuals (N = 411) and individuals with anxiety psychopathology (N = 253) completed self-report questionnaires. Results supported a hierarchical factor structure with 2 higher order factors with AS as a lower order factor of DT. The implications of these findings for the conceptualization of the relationships among AS, DT, and DI are discussed.

Anxiety sensitivity as an incremental predictor of later anxiety symptoms and syndromes.

Although anxiety sensitivity (AS) has been shown to predict anxiety symptoms and panic, this literature is limited in regard to evaluating AS as an incremental predictor of anxiety psychopathology relative to other established risk factors including sex and negative affect. The present report prospectively evaluated whether AS was predictive of later changes in anxiety symptoms after controlling for potential confounding factors. Consistent with hypothesis, AS was found to be a significant, incremental predictor of anxiety symptoms over time, even after controlling for sex and negative affectivity. These data provide novel evidence for the unique association between AS of the development of anxiety symptoms.

Reduction of cognitive concerns of anxiety sensitivity is uniquely associated with reduction of PTSD and depressive symptoms: a comparison of civilians and veterans.

PTSD and comorbid depression are common among civilians and veterans, resulting in substantial impairment. Anxiety sensitivity (AS) may be a common malleable vulnerability factor for PTSD and depression. The AS cognitive concerns subscale is most strongly related to symptoms of PTSD and depression, and thus, may be an efficient route to reduce these symptoms. The current study evaluated a brief computerized intervention targeting AS cognitive concerns. Specifically, we evaluated whether reduction in AS cognitive concerns was associated with reduction in symptoms of PTSD and depression. Also, we evaluated whether there was a significant difference between civilians and veterans in response to the intervention. The single session intervention utilized psychoeducation and interoceptive exposure to target AS cognitive concerns. This intervention was compared to a health information condition among a sex-matched sample of civilians and veterans with elevated AS cognitive concerns (N = 56). Reduction in AS cognitive concerns over one month was uniquely associated with reduction in PTSD and depressive symptoms in the same time frame. There were no significant differences between civilians and veterans in response to the intervention suggesting the intervention has efficacy for both groups. Treatment implications are discussed.

Efficacy of a prevention program for postpartum obsessive–compulsive symptoms

Obsessive-Compulsive Disorder (OCD) has emerged as a common and impairing postpartum condition. Prospective studies have identified psychological vulnerabilities for the emergence of postpartum obsessive-compulsive symptoms (OCS), including general anxiety symptoms, pre-existing OCS, and specific cognitive distortions. The identification of these factors makes feasible the development of prevention programs that could reduce the impact of postpartum OCS. The present investigation examined a cognitive-behavioral prevention program using a randomized, double blind, controlled trial. Expecting mothers in their 2nd or 3rd trimester with an empirically established, malleable risk factor for postpartum OCS received either the prevention program (N=38) or a credible control program (N=33), both of which were incorporated into traditional childbirth education classes. Results revealed that at 1 month, 3 months, and 6 months postpartum, the prevention program was associated with significantly lower levels of obsessions and compulsions than was the control condition (all ps<0.05). Group differences remained significant even after controlling for baseline OCS and depression symptoms. Those in the prevention condition also reported decreasing levels of cognitive distortions, in contrast to the control condition (ps<0.05). Results support the potential utility of incorporating a CBT-based OCS prevention program into childbirth education classes.

Gender moderates the self-regulatory consequences of suppressing emotional reactions to sexism

This study examined whether members of low-status, stigmatized groups are less susceptible to the negative cognitive consequences of suppressing their emotional reactions to prejudice, compared with members of high-status, non-stigmatized groups. Specifically, we examined whether regulating one s emotional reactions to sexist comments—an exercise of self-regulation—leaves women less cognitively depleted than their male counterparts. We hypothesized that the greater practice and experience of suppressing emotional reactions to sexism that women are likely to have relative to men should leave them less cognitively impaired by such emotion suppression. Results were consistent with this hypothesis. Moreover, these results suggest that our social group memberships may play an important role in determining which social demands we find depleting.

An Experimental Manipulation of Social Comparison in Social Anxiety

Negative self-appraisal is thought to maintain social anxiety particularly when comparing oneself to others. Work on social comparison suggests that gender may moderate the effects of social comparison in social anxiety. Self-appraisals of the desirability of ones personality may be more important to women, whereas self-appraisal of signs of anxiety may be more important to men. Within each gender, those with high social anxiety are expected to report more negative self-appraisal when comparing themselves to someone else described as high achieving. This study is the first we are aware of that examined gender-based interactive effects after a social comparison manipulation. Participants read a bogus profile of a fellow students adjustment to college. They were randomly assigned to read a profile suggesting that the fellow student was “high achieving” or more normative in his/her achievements. When comparing to a “high achieving” individual, men with high social anxiety reported the most negative self-appraisals of their signs of anxiety. In addition, greater social anxiety was associated with a poorer self-appraisal of personality only among men. The implications of the findings for conceptualizing the role of social comparison in social anxiety are discussed.

Cold Pressor “Augmentation” Does Not Differentially Improve Treatment Response for Spider Phobia

An emerging literature suggests that memory enhancement may augment the effects of learning-based treatments such as cognitive behavioral therapy. Release of stress hormones, such as cortisol, has been shown to enhance memory. In this report, we evaluated whether a cold pressor stressor (CPS), which reliably generates stress hormones, may also augment treatment for specific phobias. Spider phobics were randomly assigned to CPS or warm water bath following a standardized session of exposure therapy. Inconsistent with our hypothesis, the CPS condition showed no significant enhancement in fear reduction compared to the control condition.