Nicole A. Short

Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence.

BACKGROUND AND OBJECTIVES The present study is the first to explore links between PTSD and cannabis use characteristics immediately prior to a cannabis quit attempt, including motives, use problems, withdrawal, and craving. METHODS Measures of PTSD diagnosis, symptom severity, and cannabis use characteristics were administered to a sample of cannabis dependent military veterans (n = 94). Hypotheses were tested with a series of analyses of variance and covariance and hierarchical multiple regressions with Bonferroni corrections. Analyses were conducted with and without adjusting for variance shared with substance use (cannabis, alcohol, tobacco) in the previous 90 days, and co-occurring mood, anxiety, and substance use diagnoses. RESULTS AND CONCLUSIONS Compared to participants without PTSD, participants with PTSD reported significantly increased: (a) use of cannabis to cope, (b) severity of cannabis withdrawal, and (c) experiences of craving related to compulsivity, emotionality, and anticipation, with findings regarding coping and craving remaining significant after adjusting for covariates. Among the total sample, PTSD symptom severity was positively associated with (a) use of cannabis to cope, (b) cannabis use problems, (c) severity of cannabis withdrawal, and (d) experiences of craving related to compulsivity and emotionality, with findings regarding withdrawal and emotion-related craving remaining significant after adjusting for covariates. Thus, links between PTSD and using cannabis to cope, severity of cannabis withdrawal, and especially craving appear robust across measures of PTSD and analytical method. SCIENTIFIC SIGNIFICANCE The results of this study provide support for models that posit a pernicious feedback loop between PTSD symptomatology and cannabis use.

Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event

Intolerance of uncertainty (IU) has been associated with elevated post-traumatic stress symptoms (PTSS) in the extant literature. However, no research to date has investigated whether pre-trauma IU predicts PTSS following trauma exposure. The current study prospectively examined the relationship between IU and PTSS within a sample of individuals with various levels of exposure to a university campus shooting. We hypothesized that pre-trauma IU would predict elevated PTSS following a campus shooting, even after covarying for anxiety sensitivity (AS), a known correlate of PTSS. Participants included undergraduates (n=77) who completed a self-report battery in Introductory Psychology. After a campus shooting, they were invited to complete measures of PTSD symptoms and level of exposure to the shooting. As anticipated, results revealed pre-trauma IU as a significant predictor of elevated PTSS following the campus shooting. These results remained significant after covarying for pre-trauma levels of AS. Our results are the first to demonstrate that elevated pre-trauma levels of IU predict later PTSS following exposure to a traumatic event. This finding is discussed in terms of promising directions for future research and treatment strategies.

The effects of an anxiety sensitivity intervention on insomnia symptoms

OBJECTIVE Recent work suggests a link between a transdiagnostic vulnerability factor, anxiety sensitivity (AS), and sleep disturbance. Although research has indicated that AS is malleable through brief interventions, no studies have yet examined whether interventions targeting AS will reduce symptoms of insomnia. Considering this gap in previous research, the current study tested the direct and indirect effects of a brief, computerized intervention targeting AS on self-reported insomnia symptoms. METHODS Community participants (N = 97) were randomized into either the AS intervention (consisting of psychoeducation and interoceptive exposure) or a health information control condition, and they were assessed at baseline and at 1-month follow-up. RESULTS Findings indicated that symptoms of insomnia were related to AS and its subfactors at baseline and follow-up. Moreover, there was an indirect effect of the treatment on insomnia symptoms through AS and its subfactors, which held after covarying for baseline symptoms of anxiety and depression. CONCLUSIONS These preliminary findings suggest that targeting AS may be a brief and effective way to reduce symptoms of insomnia, but it should be replicated in a clinical sample of individuals with a diagnosis of insomnia disorder.

Direct and Mediating Effects of an Anxiety Sensitivity Intervention on Posttraumatic Stress Disorder Symptoms in Trauma-Exposed Individuals

Anxiety sensitivity (AS), or fear of anxious arousal, is a higher-order cognitive risk-factor for posttraumatic stress disorder (PTSD) composed of lower-order physical, cognitive, and social concerns regarding anxiety symptoms. Brief and effective interventions have been developed targeting AS and its constituent components. However, there is limited evidence as to whether an intervention aimed at targeting AS would result in reductions in PTS symptoms and whether the effects on PTS symptoms would be mediated by reductions in AS. Furthermore, there is no evidence whether these mediation effects would be because of the global or more specific components of AS. The direct and indirect effects of an AS intervention on PTS symptoms were examined in a sample of 82 trauma-exposed individuals (M age = 18.84 years, SD = 1.50) selected based on elevated AS levels (i.e., 1 SD above the mean) and assigned to either a treatment (n = 40) or an active control (n = 42) condition. Results indicated that the intervention led to reductions in Month 1 PTS symptoms, controlling for baseline PTS symptoms. Furthermore, this effect was mediated by changes in global AS and AS social concerns, occurring from intervention to Week 1. These findings provide an initial support for an AS intervention in amelioration of PTS symptoms and demonstrate that it is primarily reductions in the higher-order component of AS contributing to PTS symptom reduction.

Obsessive-compulsive symptom dimensions and insomnia: The mediating role of anxiety sensitivity cognitive concerns.

Existing research on the relationship between obsessive-compulsive disorder (OCD) and insomnia is scarce. Moreover, no research has examined potential mechanisms that may account for the observed relations among OCD and sleep difficulties. The cognitive concerns subscale of anxiety sensitivity (AS), which reflects fears of mental incapacitation, has been linked to both symptoms of OCD and insomnia and may serve as a mechanism for increasing sleep disturbance among patients with OCD. The current study examined the relationship between OCD symptoms and insomnia and the potential mediating role of AS cognitive concerns. The sample consisted of 526 individuals recruited through Amazons Mechanical Turk (Mturk), an online crowdsourcing marketplace. Results revealed distinct associations between the unacceptable thoughts domain of OCD and symptoms of insomnia. Additionally, AS cognitive concerns mediated the relationship between these constructs. Future research should seek to replicate these findings using clinical samples and prospective designs.

Insomnia and emotion dysregulation: Independent and interactive associations with posttraumatic stress symptoms among trauma-exposed smokers

INTRODUCTION Traumatic event exposure is common among cigarette smokers, and elevated posttraumatic stress symptoms (PTSS) are associated with increased smoking levels. As such, the current study examined factors that may contribute to elevated PTSS among trauma-exposed smokers. Insomnia and emotion dysregulation may be particularly relevant among smokers, and are each associated with PTSS. However, it remains unclear whether these factors are associated with PTSS after accounting for the effects of dispositional factors and each other, and whether they may interact to predict PTSS. Thus, the current study sought to test whether insomnia and emotion dysregulation are independently associated with PTSS after accounting for negative affectivity and number of traumas experienced, and to investigate the potential interactive influence of these factors on PTSS. METHOD Hypotheses were tested cross-sectionally among a community sample of trauma-exposed individuals who presented for smoking cessation treatment (n=349). RESULTS Results demonstrated that insomnia and emotion dysregulation each predicted elevated PTSS after controlling for the other, negative affectivity and number of traumas experienced. In addition, the interaction between insomnia and emotion dysregulation was significant, such that higher levels of insomnia and emotion dysregulation were associated with the most severe PTSS. LIMITATIONS Future research should examine these factors among a clinical sample of individuals with PTSD, as well as utilize prospective designs. CONCLUSIONS Findings highlight the roles of insomnia and emotion dysregulation in contributing to elevated PTSS among trauma-exposed smokers, and the potential importance of targeting these factors in the context of PTSD treatment.

Cannabis use disorder treatment barriers and facilitators among veterans with PTSD.

In light of recent data demonstrating large variability in the diagnosis of cannabis use disorders (CUDs) within the Veterans Affairs Health Care System (VA), it is important to elucidate VA-specific barriers and facilitators to CUD diagnosis and treatment engagement. This issue is particularly salient among veterans with posttraumatic stress disorder (PTSD), given that PTSD is the most common co-occurring psychiatric disorder among veterans with CUD and is associated with poorer treatment outcomes. The goal of the current study was to evaluate the potential role of system-, clinician-, and patient-level factors associated with both CUD diagnosis and treatment engagement. Key personnel were interviewed from PTSD programs with both low and high rates of CUD and substance use disorder (SUD) programs with both low and high rates of SUD treatment engagement. Common themes emerged across clinics that may represent barriers to CUD diagnosis and treatment engagement and included, for example, clinicians concerns about negative consequences associated with CUD diagnosis (e.g., service connection). Potential facilitators to CUD diagnosis and treatment also emerged and included the use of formal assessment approaches when evaluating veterans for SUDs. Together, findings suggest opportunities, such as CUD-specific education and training for clinicians, to improve VA care.

Anxiety Sensitivity Prospectively Predicts Posttraumatic Stress Symptoms Following a Campus Shooting.

Anxiety sensitivity (AS), the feared consequences of anxious arousal, is known to be related to posttraumatic stress symptoms (PTSS) concurrently and longitudinally. However, no studies have demonstrated whether AS prior to a Criterion A traumatic event predicts later PTSS. The present study evaluated whether preshooting AS predicted PTSS following a campus shooting, as well as whether preshooting AS interacted with shooting exposure to predict PTSS. Participants comprised undergraduates (N=71) who completed a self-report battery upon enrolling in Introductory Psychology. After a campus shooting later in the semester, they were invited to complete measures of PTSS and level of exposure to the shooting. Preshooting levels of AS significantly predicted PTSS after the shooting. This effect was qualified by a significant AS by shooting exposure interaction, such that those with high AS who were exposed to the shooting reported the greatest levels of PTSS. Though all three of the preshooting physical, cognitive, and social AS subfactors demonstrated main effects significantly predicting postshooting PTSS, only AS physical concerns significantly interacted with shooting exposure. The implications of this study concerning AS as a causal risk factor for PTSD are discussed.

Specific and general facets of hoarding: A bifactor model

Whereas it has been suggested that hoarding is a multidimensional construct comprising distinct but interrelated factors (i.e., difficulty discarding, excessive clutter, and excessive acquisition), a high degree of overlap as well as a lack of discriminant validity among these factors and exogenous constructs suggests that a correlated factors approach may not adequately capture this phenomenon. The factor structure of the Saving Inventory Revised (SIR) was examined in a large non-selected clinic sample (N=490). A bifactor model of hoarding, comprising a general Hoarding factor and orthogonal Urge-Related Acquiring, Distress-Related Acquiring, Difficulty Discarding, and Clutter factors fit the data best. Further, whereas the general Hoarding factor was related to several depression facets, the specific hoarding factors demonstrated differential relations with depression. This study establishes that acquiring behaviors are motivated by both positive/urge-related and negative/distress-related emotions. Additionally, general and distinct factors should be considered to properly contextualize hoarding behavior.

Hoarding and eating pathology: The mediating role of emotion regulation

Hoarding disorder is characterized by persistent difficulty discarding possessions resulting in clutter that precludes one from using living areas for their intended purposes. The limited empirical work available has suggested a strong link between hoarding and various non-psychiatric conditions, including obesity. Despite these associations, no research has examined the link between hoarding and other forms of eating pathology including symptoms associated with binge eating. Moreover, little is known about mechanisms that may account for this relationship. The current study examined the associations between hoarding severity, obesity, and symptoms associated with binge eating in a sample (N=97) of individuals with elevated hoarding symptoms. Results revealed that hoarding severity was associated with increased body mass index (BMI) and symptoms of binge eating. In addition, difficulties regulating emotions mediated the association between hoarding and eating concerns. Considering the lack of information on hoarding behaviors, as well as its classification as a new diagnosis within DSM-5, these findings add considerably to a growing body of literature on hoarding disorder.