Susan R. Battista

A Critical Review of Laboratory-Based Studies Examining the Relationships of Social Anxiety and Alcohol Intake

Research has revealed inconsistencies regarding the relationship between social anxiety and alcohol use. The goal of the current review is to examine lab-based studies that have been conducted in an attempt to help disentangle the social anxiety - alcohol link. Specifically, this review focuses on the most prominent theories present in this area of research, namely, the Tension Reduction Theory, the Stress-Response Dampening Model, the Self-Awareness Model, the Attention Allocation Model, and the Appraisal-Disruption Model. The review then describes the empirical studies that have been conducted to test predictions derived from each of these theories. This is followed by a discussion of some methodological considerations in this area of research, including an examination of participant characteristics, study selection criteria, alcohol administration procedures, the nature of the anxiety-inducing tasks that have been used in this area of research, and the different types of outcome measures that are typically used to measure social anxiety. The review ends with some tentative conclusions and directions for future research, including recommendations to recruit individuals with high levels of trait social anxiety, to closely monitor blood alcohol levels achieved at different time points during the study, to examine more interaction-based social anxiety provoking tasks, and to employ a wider range of outcome measures (e.g., cognitive and behavioural outcomes relevant to social anxiety).

Mindfulness and Psychopathology: Problem Formulation

Mindfulness-based interventions are currently being used with a variety of populations to treat a wide range of physical and psychological disorders. For example, Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990) has been used to treat chronic pain and anxiety, among other conditions. Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002) has been used for the prevention of relapse in depression. Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) includes elements of mindfulness and has been used with a wide variety of patients. Finally, Dialectical Behavior Therapy (DBT; Linehan, 1993) incorporates mindfulness as a core skill in the treatment of borderline personality disorder. With the growing number of mindfulness-based interventions, and the growing evidence supporting the use of some of these interventions, clinicians are understandably interested in continuing to apply mindfulness to a wide variety of concerns. However, the danger of over-applying mindfulness as a treatment for psychopathology exists. Additionally, the application of a generic mindfulness program to a wide variety of complaints may not be as efficacious as tailoring the mindfulness intervention to a specific problem. In addition to tailoring a mindfulness intervention to a specific complaint, an integrative approach, one in which evidence-based interventions are retained and mindfulness is incorporated in a theoretically consistent manner, may lead to the most favorable outcomes. The primary goal of this chapter is to highlight the importance of taking a problem formulation approach in the development and use of mindfulness interventions. Related to this, a secondary aim of this chapter is to review current theory and research on mechanisms of change of mindfulness interventions in the reduction of psychological distress and also to encourage further research in this area. A clear understanding of how mindfulness interventions lead to positive outcomes is essential for therapists, as it will enhance problem formulation.

Getting the party started — Alone: Solitary predrinking mediates the effect of social anxiety on alcohol-related problems ☆

Predrinking (or pregaming) is common among undergraduates and has been linked with problem alcohol use. While many students predrink to save money, evidence suggests that some students predrink to cope with social anxiety (SA). Tension reduction and cognitive theories predict that those high in SA may predrink to reduce anticipatory anxiety before attending social events and their predrinking may be done alone rather than in normative social contexts. Available data suggest that, relative to social drinking, solitary drinking elevates risk for alcohol use and related problems. Informed by this evidence, we speculated that context for predrinking may be an important mechanism by which SA-risk for alcohol use unfolds. Specifically, we offered the novel hypothesis that those high in SA would engage frequently in solitary predrinking and this in turn would be associated with elevated alcohol use and related problems. Undergraduate drinkers (N=293; 70% women) completed self-reports of social anxiety, predrinking context (social, solitary), alcohol use, and alcohol-related problems. In partial support of our hypotheses, SA was a positive predictor of solitary predrinking, which in turn predicted elevated alcohol-related problems, but not alcohol use. While not hypothesized, we also found that SA was a negative predictor of social predrinking, which in turn reduced risk for alcohol use and related problems. Our study is the first in the literature to show that solitary predrinking helps explain the well-documented association between SA and alcohol-related problems. These findings may inform etiological models and clinical interventions, suggesting that SA-risk for problem drinking begins even before the party starts.

Relations of Personality to Substance Use Problems and Mental Health Disorder Symptoms in Two Clinical Samples of Adolescents

There is a high overlap between substance misuse and mental health disorders in adolescents. Certain personality traits (i.e., sensation seeking, impulsivity, hopelessness, and anxiety sensitivity) may be related to increased risk for mental health symptoms and/or substance misuse. The current study examined the relationships between personality and both substance use problems and externalizing and internalizing mental health symptoms in two clinical samples of adolescents. One sample consisted of adolescents receiving treatment for a primary mental health disorder, while the other sample included adolescents receiving treatment for a primary substance use disorder. A total of 116 participants (58 for each sample) completed the Substance Use Risk Profile Scale (SURPS), to examine personality factors, the Brief Child and Family Phone Interview- Self-Report, to examine mental health disorder symptoms, and the Personal Experience Screening Questionnaire, to examine substance use problems. After controlling for age, gender, and sample, sensation seeking and impulsivity were positively related to substance use problems, impulsivity was positively related to symptoms of externalizing disorders, and anxiety sensitivity and hopelessness were positively related to symptoms of internalizing disorders. These findings support the utility of the SURPS in predicting theoretically relevant symptoms in clinical samples of adolescents. Moreover, they extend previous research that has focused on using the SURPS as a predictor of substance misuse to its utility in also predicting mental health disorder symptoms. These findings have implications for improving mental health and addictions treatment services for adolescents.

Enhancement motives moderate the relationship between high-arousal positive moods and drinking quantity: Evidence from a 22-day experience sampling study.

INTRODUCTION AND AIMS Individuals who consume alcohol may be distinguished by their drinking motives. Enhancement motives involve drinking to enhance positive moods. Research on the moderating effect of enhancement motives on the within-person relation between daily positive mood and drinking has not differentiated between high- (e.g. hyper) and low-arousal (e.g. cheerful) positive moods. The present study addressed this limitation. We hypothesised that enhancement motives would positively moderate the relationship between mid-afternoon high-arousal positive mood and evening drinking. DESIGN AND METHODS Using a palm pilot-based experience sampling design, 143 undergraduate drinkers answered daily surveys assessing positive mood (mid-afternoon) and drinks (evening) for 22 consecutive days. RESULTS As hypothesised, enhancement motives strengthened the relation between high-arousal positive moods and drinking. Upon closer examination, the mood-drinking slope for those high in enhancement motives was unexpectedly flat, whereas the mood-drinking slope for those low in enhancement motives was negative. DISCUSSION AND CONCLUSIONS We demonstrated that high enhancement-motivated drinkers exhibit a high, stable drinking level, regardless of the intensity of their high-arousal positive mood. In contrast, low enhancement-motivated drinkers decrease their drinking when in a high-arousal positive mood state. Clinicians may be able to help reduce heavy alcohol consumption in enhancement-motivated drinkers by teaching them to reduce their drinking when in a high-arousal positive mood state.