Study protocol for approach bias retraining for nicotine addiction among dual combustible and electronic cigarette users.

BACKGROUND: Electronic cigarette (ECIG) use has become a popular method for nicotine delivery. Combustible cigarette (CC) cessation or reduction are the primary reasons for ECIG uptake among adults. Yet, most CC smokers who initiate ECIG use do not fully transition from CC to ECIG, despite intending to quit CC completely. Retraining approach bias, or the approach action tendency toward stimuli related to the substance of interest, has been effective in alcohol and CC use treatments. However, approach bias retraining for both CC and (ECIG) users has not been explored. Therefore, the objective of the study is to evaluate the initial efficacy of approach bias retraining among dual CC and ECIG users. METHODS: Eligible dual CC/ECIG using adults (N = 90) will complete a phone-screener, baseline assessment, 4 treatment sessions over 2 weeks, ecological momentary assessments (EMAs) post-intervention, and follow-ups at 4- and 6-week post-intervention. Participants will be assigned to one of three conditions at baseline: (1) CC + ECIG retraining; (2) CC only retraining; and (3) sham retraining. Participants will engage in a self-guided quit attempt to abstain from all nicotine products starting at treatment session 4. CONCLUSIONS: The study may lead to a more effective treatment for at-risk nicotine users while simultaneously isolating explanatory mechanisms. The findings should guide advances in the theoretical conceptualization of nicotine addiction for dual users and mechanisms involved in maintaining and abstaining from CC and ECIG, and provide initial effect size data for a brief intervention, thus providing necessary data for a large-scale follow-up trial. Clinical Trials ID: NCT05306158.

Posttraumatic stress among trauma-exposed Hispanic/Latinx adults: relations to mental health.

Latinx persons are exposed to higher rates of traumatic events and conditional risks for developing posttraumatic stress disorder (PTSD) symptoms and comorbid mental health symptoms compared to other minority groups. The study evaluated PTSD symptom severity for global and specific cluster severity relating to co-occurring anxiety, social anxiety, depression, and suicidal ideation among 326 Latinx adults who endorsed trauma exposure. Results indicated that global PTSD symptom severity was significantly related to greater social anxiety, anxious arousal, depression, and suicidal ideation symptoms. PTSD arousal and reactivity symptom cluster had the strongest relation to anxious arousal, social anxiety, and depression, whereas negative alterations in cognitions and mood symptoms had the strongest association with social anxiety, depression, and suicidal ideation. The findings suggest that global PTSD symptom severity, alongside arousal and reactivity and negative alterations in cognitions and mood, are related to a range of concurrent negative mental health symptoms among trauma exposed Latinx young adults.

Anxiety sensitivity and reasons for smoking among Black smokers.

Black smokers demonstrate higher nicotine dependence and experience higher rates of smoking-related diseases and mortality relative to European American/White smokers. A potential factor relevant to race-specific smoking health disparities may be smoking motives (i.e., motivational basis of smoking). Yet, little research has been conducted to understand psychological factors that may be associated with specific smoking motives among Black smokers. To address this gap in the literature, the current study explored the association between anxiety sensitivity and smoking motives within a subset sample of Black smokers who were interested in participating in a smoking cessation trial (N = 105; 70.5 % male; Mage = 44.8 years, SD = 11.6 years). Hierarchical regression analyses indicated anxiety sensitivity was associated with smoking motives related to habit (ß = 0.39, p <.001), negative affect reduction (ß = 0.32, p <.001), stimulation (ß = 0.31, p <.001), and sensorimotor manipulation (ß = 0.26, p =.008). Limited support was found for the effect of motives on past quit attempt engagement. These results may broaden understanding of the psychological mechanisms related to smoking motivation among Black smokers and may inform future intervention efforts to reduce smoking motivation among this health disparities population.

Evaluating resilience in terms of COVID-19 related behavioral health among Latinx adults during the coronavirus pandemic.

The mental and behavioral health burden resulting from COVID-19 has disproportionately affected the Latinx population. Yet, no work has investigated the influence of resilience as a protective factor against COVID-19 related consequences. The aim of the current study was to evaluate resilience in relation to COVID-19 related fear, anxiety symptoms, COVID-19 anxiety-related sleep disturbances, and depression among Latinx persons (178 Latinx persons [31.5% female, Mage = 34.1 years, SD = 8.2]). It was hypothesized that greater levels of resilience would be associated with lower levels of all COVID-19 related behavioral health outcomes above and beyond the variance accounted for by years living in the United States (U.S.), degree of COVID-19 exposure, sex, age, education, and COVID-19 related work and financial troubles and home-life distress. Results indicated that greater levels of resilience were associated with lower levels of COVID-19 related fear (ΔR2 = .06, p < .001), anxiety symptoms (ΔR2 = .03, p = .005), COVID-19 anxiety-related sleep disturbances (ΔR2 = .06, p < .001), and depression (ΔR2 = .04, p = .001). Overall, the present study is the first to document the potential importance of resilience in relation to common and clinically significant COVID-19 behavioral health problems among Latinx persons.

A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial.

BACKGROUND: Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. OBJECTIVE: This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. METHODS: The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. RESULTS: Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19-specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. CONCLUSIONS: Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40713.

Anxiety sensitivity and its association with perceived barriers for quitting, smoking inflexibility, and severity of quit problems among Black smokers.

Black individuals who smoke in the United States experience health disparities related to tobacco use (e.g., greater nicotine dependence, less success in quitting smoking) and interoceptive distress (e.g., somatic symptoms, anxiety). Individual difference factors that amplify interoceptive distress and contribute to poorer smoking behaviors and outcomes warrant further attention and investigation. Thus, the present study sought to explore the association between anxiety sensitivity and clinically-relevant smoking variables of perceived barriers for quitting, smoking inflexibility, and problems experienced during past quit attempts. Participants in the current study included 98 Black adult smokers (71.4% male; Mage = 44.08 years, SD = 11.44 years). Results indicated greater levels of anxiety sensitivity were associated with greater levels of perceived barriers for quitting smoking (b = 0.10, SE = 0.08, p = 0.01), smoking inflexibility (b = 0.02, SE <.001, p <.001), and problems experienced during past smoking quit attempts (b = 0.17, SE = 0.07, p = 0.02). Clinical implications and future directions are further discussed as it relates to anxiety sensitivity and efforts to reduce or quit smoking for this health disparities population.

Trauma exposure and smoking outcomes: The indirect effects of anxious and depressive symptoms.

With a direct link between traumatic stress and poor smoking outcomes established, there is a clinically important need to identify underlying, targetable mechanisms that maintain these relations. The present study employed a parallel mediation model to assess the competing explanatory significance of four distinct facets of depression and anxiety (general anxiety, anxious arousal, general depression, and anhedonic depression) in the relation between traumatic load and perceived barriers for quitting smoking, severity of psychosomatic problems experienced when attempting to quit smoking in the past, and negative reinforcement expectancies related to smoking among 98 adult trauma-exposed daily smokers (Mage = 44.64, SD = 10.66). Results showed that only general anxiety symptoms, when controlling for the competing facets of depression and anxiety, had a statistically significant indirect effect on the relation between traumatic load and all smoking processes, such that general anxiety symptoms significantly, indirectly influenced the relation between traumatic load and barriers for smoking cessation (ab = 0.95, 95% CI [0.163, 0.2.14]), smoking quit problems (ab = 0.07, 95% CI [0.009, 0.165]), and negative reinforcement smoking expectancies (ab = 0.16, 95% CI [0.025, 0.399]). Anxious arousal demonstrated an indirect effect for trauma load on only negative reinforcement smoking expectancies (ab = -0.15, 95% CI [-0.345, -0.023]). The current findings highlight the potential importance of general anxiety symptoms as a targetable mechanism for smoking cessation treatments for trauma-exposed smokers.

Interoceptive anxiety-related processes: Importance for understanding COVID-19 and future pandemic mental health and addictive behaviors and their comorbidity.

The COVID-19 pandemic is associated with an increased prevalence of mental health problems and addictive behaviors. There is a growing theoretical and empirical evidence that individual differences in interoceptive anxiety-related processes are a one set of vulnerability factors that are important in understanding the impact of pandemic-related mental health problems and addictive behavior. However, there has not been a comprehensive effort to explore this rapidly growing body of research and its implications for public health. In this paper, we discuss why interoceptive anxiety-related processes are relevant to understanding mental health and addictive behaviors during the COVID-19 pandemic. We then provide a narrative review of the available COVID-19 literature linking interoceptive fear and anxiety-related processes (e.g., anxiety sensitivity, health anxiety, and COVID-19 anxiety, fear, and worry) to mental health and addictive behaviors. We then propose a novel transdiagnostic theoretical model that highlights the role of interoceptive anxiety-related processes in mental health and addictive behavior in the context of the present and future pandemics. In the final section, we utilize this conceptualization to underscore clinical implications and provide guidance for future research initiatives in the management of COVID-19 mental health and addictive behaviors and inform the public health field for future pandemics.

Evaluating Experiential Avoidance in terms of COVID-19 Fear and Pandemic Emotional Distress Symptoms Among Latinx Adults.

BACKGROUND: The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial psychological distress across the United States and the world. However, emerging work suggests that prominent COVID-19 consequences such as fear of COVID-19 infection and emotional distress resulting from economic adversity and social distancing may afflict the Latinx population disproportionately. The current study sought to investigate the influence of experiential avoidance (EA), or an individual's tendency to rigidly avoid negative internal experiences (i.e. feelings, thoughts, etc.), on the severity of COVID-19 fear and emotional distress symptoms due to economic adversity and social distancing. METHOD: Participants included 188 Latinx persons recruited via an online survey panel program. RESULTS: Results indicated that EA was a statistically significant contributing factor to fear of COVID-19 and emotional distress associated with economic adversity and social distancing. These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and COVID-19 related work and home life stress. CONCLUSIONS: Overall, the present work is the first to document empirically EA as it relates to fear of COVID-19 infection and related emotional distress resulting from economic adversity and social distancing among Latinx persons.

Anxiety Sensitivity and Fatigue Severity Among Adults with Chronic Low Back Pain.

Background: The combined impact of chronic low back pain (CLBP) and fatigue severity is associated with increased burden and worsened symptoms. Understanding factors that may contribute to and maintain fatigue severity among individuals with CLBP is needed to isolate intervention modalities. Methods: The current study sought to investigate the role of anxiety sensitivity (AS) in terms of fatigue severity among 1,663 adults (70.0% female, M age = 44.5 years, SD = 11.87) with current mild to severe CLBP as well as a subset of the sample with clinically significant fatigue (n = 778). Results: Results indicated AS was a positively and statistically significant predictor of fatigue severity among the entire sample and the subset of the sample with clinically significant fatigue. Conclusions: These cross-sectional data highlight the potential promise of AS as an underrecognized cognitive vulnerability for greater fatigue severity among those with CLBP.