Scarlett O. Baird

The Efficacy of Vigorous-Intensity Exercise as an Aid to Smoking Cessation in Adults With High Anxiety Sensitivity: A Randomized Controlled Trial.

Objectives High anxiety sensitivity predicts poor smoking cessation outcomes. Aerobic exercise reduces anxiety sensitivity and aspects of the risk conferred by anxiety sensitivity. In the current study, we examined whether exercise can aid smoking cessation in adults with high anxiety sensitivity. Methods Participants were sedentary and low-activity adult daily smokers (n = 136) with elevated prescreen anxiety sensitivity. Participants received 15 weeks of standard smoking cessation treatment (ST; cognitive behavioral therapy plus nicotine replacement therapy). In addition, participants were simultaneously randomized to 15 weeks of either an exercise intervention (ST + EX; n = 72) or a wellness education control condition (ST + CTRL; n = 64). Self-reported smoking abstinence was assessed weekly during the intervention, at the end of treatment (10 weeks after the target quit date), and at 4 and 6 months after the target quit date. Abstinence was verified by expired carbon monoxide readings and saliva cotinine. Results Results indicated that point prevalence abstinence (PPA) and prolonged abstinence (PA) rates were significantly higher for ST + EX than for ST + CTRL at each of the major end points among persons with high anxiety sensitivity (PPA: b = −0.91, standard error [SE] = 0.393, t(1171) = −2.33, p = .020; PA: b = −0.98, SE = 0.346, t(132) = −2.84, p = .005), but not among those with low anxiety sensitivity (PPA: b = −0.23, SE = 0.218, t(1171) = −1.06, p = .29; PA: b = −0.31, SE = 0.306, t(132) = −1.01, p = .32). Conclusions The present results suggest that exercise facilitates the odds of quit success for smokers with high levels of anxiety sensitivity and therefore may be a useful therapeutic tactic for this high-risk segment of the smoking population. Trial Registration: ClinicalTrials.gov, NCT01065506.

The Effects of a Hatha Yoga Intervention on Facets of Distress Tolerance

Individuals with low distress tolerance (DT) experience negative emotion as particularly threatening and are highly motivated to reduce or avoid such affective experiences. Consequently, these individuals have difficulty regulating emotions and tend to engage in maladaptive strategies, such as overeating, as a means to reduce or avoid distress. Hatha yoga encourages one to implement present-centered awareness and non-reaction in the face of physical and psychological discomfort and, thus, emerges as a potential strategy for increasing DT. To test whether a hatha yoga intervention can enhance DT, a transdiagnostic risk and maintenance factor, this study randomly assigned females high in emotional eating in response to stress (N = 52) either to an 8-week, twice-weekly hatha (Bikram) yoga intervention or to a waitlist control condition. Self-reported DT and emotional eating were measured at baseline, weekly during treatment, and 1-week post-treatment. Consistent with prediction, participants in the yoga condition reported greater increases in DT over the course of the intervention relative to waitlist participants (Cohens d = .82). Also consistent with prediction, the reduction in emotional eating was greater for the yoga condition than the waitlist condition (Cohens d = .92). Importantly, reductions distress absorption, a specific sub-facet of DT, accounted for 15% of the variance in emotional eating, a hallmark behavior of eating pathology and risk factor for obesity.

Emotion dysregulation explains relations between sleep disturbance and smoking quit-related cognition and behavior

Poor sleep quality and tobacco use are common and co-occurring problems, although the mechanisms underlying the relations between sleep disturbance and smoking are poorly understood. Sleep disturbance lowers odds of smoking cessation success and increases odds of relapse. One reason may be that sleep loss leads to emotion dysregulation, which in turn, leads to reductions in self-efficacy and quit-related problems. To address this gap, the current study examined the explanatory role of emotion dysregulation in the association between sleep disturbance and smoking in terms of (1) self-efficacy for remaining abstinent in relapse situations, (2) the presence of a prior quit attempt greater than 24h, and (3) the experience of quit-related problems among 128 adults (Mage=40.2; SD=11.0; 52.3% female) seeking treatment for smoking cessation. Results suggested that increased levels of sleep disturbance are related to emotion dysregulation which, in turn, may lead to lower levels of self-efficacy for remaining abstinent, more quit-related problems, and being less likely to have had a quit attempt of 24h or greater. Further, these indirect effects were present above and beyond variance accounted for by theoretically-relevant covariates (e.g., gender and educational attainment), suggesting that they may maintain practical significance. These findings suggest that this malleable emotional risk factor (emotion dysregulation) could serve as a target for intervention among those with poor sleep and tobacco use.

Distress Tolerance as a Predictor of Adherence to a Yoga Intervention Moderating Roles of BMI and Body Image

This study tested whether distress tolerance, body image, and body mass index (BMI) predicted adherence to a yoga intervention. Participants were 27 women who participated in a yoga intervention as part of a randomized controlled trial. Attendance and distress tolerance were assessed weekly, and body image and BMI were measured at baseline. Multilevel modeling revealed a three-way interaction of distress tolerance, BMI, and body image (p < .001). For participants with few body image concerns, distress tolerance was positively associated with adherence regardless of BMI (p = .009). However, for those with poor body image, increases in distress tolerance were associated with increases in adherence among overweight participants (p < .001) but lower adherence among obese participants (p = .007). Distress tolerance may be implicated in adherence to a yoga intervention, although its effects may be dependent on body image concerns, BMI, and their interaction. Research and clinical implications are discussed.

Anxiety sensitivity and smoking variability among treatment seeking smokers

Objectives:Anxiety sensitivity (AS) is associated with poor smoking cessation outcomes. One reason may be that smokers with high AS smoke differently (ie, to manage negative affect and uncomfortable bodily sensations) than other smokers, leading to stronger addiction (due to an affect/sensation based and thereby highly variable rather than a regular smoking routine). Thus, we examined the relationship between AS and smoking variability in a group of treatment-seeking smokers. Methods:Participants (N=136; 52.2% female; Mage=44.19 y, SD=11.29) were daily smokers with elevated AS (AS≥20 on the Anxiety Sensitivity Index 16-item at prescreen) recruited as part of a larger randomized controlled trial for smoking cessation. Most participants were white (73%), educated (with 76% attending some college), unmarried (73%), and employed full-time (56%). They smoked, on average, 17 cigarettes per day. Results:Consistent with prediction, a regression analysis of baseline assessments and a longitudinal analysis with multilevel modeling both showed higher AS was associated with greater variability in cigarettes smoked per day while controlling for sex, age, ethnicity, and income. Conclusions:This finding encourages investigation of how AS might interact with clinical strategies using a fixed smoking taper as part of quit attempts.

Does exercise aid smoking cessation through reductions in anxiety sensitivity and dysphoria

Objective: Research shows that high anxiety sensitivity (AS) and dysphoria are related to poor smoking cessation outcomes. Engaging in exercise may contribute to improvement in smoking cessation outcomes through reductions in AS and dysphoria. In the current study, we examined whether exercise can aid smoking cessation through reductions in AS and dysphoria. Method: Participants were sedentary and low activity adult daily smokers (N = 136) with elevated AS who participated in a randomized controlled trial comparing smoking cessation treatment (ST) plus an exercise intervention (ST + EX) to ST plus wellness education (ST + CTRL). Self-reported smoking status was assessed in-person weekly from baseline through week 16 (end of-treatment; EOT), at week 22 (4 months postquit day), and at week 30 (6 months postquit day), and verified biochemically. Results: Results indicated that both AS and dysphoria at 6-month follow-up were significantly lower in the ST + EX group compared to the ST + CTRL group (controlling for baseline levels). Moreover, reductions in AS and dysphoria emerged as independent mechanisms of action explaining success in quitting. Conclusions: These novel findings offer clinically significant evidence suggesting that vigorous-intensity exercise can effectively engage affective constructs in the context of smoking cessation.

Reducing approach bias to achieve smoking cessation: A pilot randomized placebo-controlled trial

This study aimed to provide a preliminary test of the efficacy of a brief cognitive bias modification program for reducing approach bias in adult smokers motivated to quit. Participants were 52 smokers who were randomly assigned to four sessions of approach bias modification training (AAT) or sham training. Participants were asked to make a self-guided quit attempt upon completion of the final training session. Approach bias was assessed at baseline and at the end of each session, and days abstinent was assessed 1-week following the quit attempt. Individuals assigned to the AAT training condition evidenced significantly greater reductions in approach bias relative to those in the sham condition (p < .001). Baseline approach bias did not moderate the between-group effect (ps > 0.41); however, higher levels of approach bias at baseline were associated with greater approach bias reduction over time irrespective of condition (p < .001). Consistent with hypothesis, the reduction in approach bias during the intervention period was significantly related to the number of days abstinent following the quit attempt (p = .033). The present study extends recent work in alcohol use disorders by showing that approach bias reduction, in this case for smoking-related stimuli, may also facilitate smoking cessation. Clinical and research implications are discussed.

Physical Activity and Community Engagement (PACE) to facilitate community reintegration among returning veterans: Study protocol for a randomized controlled trial

There is a surprising lack of disseminable, community-based interventions for veterans experiencing difficulties during the reintegration process from military to civilian life. Physical Activity and Community Engagement (PACE) is a program which combines routine vigorous-intensity exercise with community engagement. The program builds on emergent evidence supporting the benefits of routine vigorous-intensity exercise among and establishing social connection. Using a randomized controlled trial (N = 60), we will obtain feasibility data and initial effect sizes for the early effects of PACE on reintegration difficulties.

A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder

ABSTRACT Numerous studies have demonstrated the efficacy of cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD). Two prior meta-analyses of studies are available but used approaches that limit conclusions that can be drawn regarding the impact of CPT on PTSD outcomes. The current meta-analysis reviewed outcomes of trials that tested the efficacy of CPT for PTSD in adults and evaluated potential moderators of outcomes. All published trials comparing CPT against an inactive control condition (i.e. psychological placebo or wait-list) or other active treatment for PTSD in adults were included, resulting in 11 studies with a total of 1130 participants. CPT outperformed inactive control conditions on PTSD outcome measures at posttreatment (mean Hedges’ g = 1.24) and follow-up (mean Hedges’ g = 0.90). The average CPT-treated participant fared better than 89% of those in inactive control conditions at posttreatment and 82% at follow-up. Results also showed that CPT outperformed inactive control conditions on non-PTSD outcome measures at posttreatment and follow-up and that CPT outperformed other active treatments at posttreatment but not at follow-up. Effect sizes of CPT on PTSD symptoms were not significantly moderated by participant age, number of treatment sessions, total sample size, length of follow-up, or group versus individual treatment; but, older studies had larger effect sizes and percent female sex moderated the effect of CPT on non-PTSD outcomes. These meta-analytic findings indicate that CPT is an effective PTSD treatment with lasting benefits across a range of outcomes.

Learning Principles in CBT

Abstract Cognitive behavioral therapy (CBT) has been widely applied to a diverse range of psychopathology. CBT, as it exists today, is a composite of techniques derived from behavioral, cognitive, and social learning theories. Behavioral learning principles underlie exposure therapy, one of the most efficacious interventions to date, as well as a handful of diverse CBT interventions, which apply principles of reinforcement to decrease maladaptive behaviors. Cognitive strategies within CBT utilize principles from theories of constructivism, attribution theory, and metacognition to aid clients in learning how thoughts impact feelings. Finally, social learning theory, which focuses on learning in the context of interpersonal relationships, interactions, and observations, plays a role in CBT, relying heavily upon both therapist instruction and the active role of the participant. This chapter provides an overview of how these learning theories guide CBT strategies, yielding considerations for both clinicians and researchers on how to enhance learning within CBT.