Multiple facets of problematic anger among regular smokers: exploring associations with smoking motives and cessation difficulties.

INTRODUCTION: Research has implicated problematic anger in multiple smoking outcomes, including nicotine dependence and difficulties with cessation. However, the mechanisms underlying the role of anger in smoking behavior and cessation difficulties remain unclear. The current study examined associations between different facets of anger with smoking motives, problematic symptoms during past quit attempts, reasons for quitting, and perceived barriers to cessation. METHODS: Current smokers (N = 93) were administered measures assessing the relevant constructs. RESULTS: After controlling for gender and negative affectivity, greater trait anger was uniquely related to more severe symptoms during past cessation attempts, perceived internal and external barriers to cessation, social influence reasons for quitting, and negative affect reduction and sensorimotor smoking motivations. CONCLUSIONS: These findings add uniquely to the literature on anger and smoking and suggest anger plays a role in everyday smoking behavior. Smokers with problematic anger might benefit from treatment focused on reducing anger and improving interpersonal functioning. Reducing trait anger may help reduce problematic symptoms during quitting, making relapse less likely.

Delineating a relationship between problematic anger and cigarette smoking: a population-based study.

BACKGROUND: Research implicates a potentially important relationship between anger and smoking, though extant work suffers from a number of limitations, including the absence of controls for psychiatric comorbidity and the use of treatment-seeking samples. The current study sought to examine the unique associations between problematic anger and smoking behavior in a large representative sample. METHODS: Participants included 5,692 adults from the National Comorbidity Survey-Replication, a nationally representative survey. Assessments of psychiatric diagnoses, smoking behavior, and problematic anger were administered. RESULTS: Results indicated that problems of anger experience were significantly associated with past-year daily smoking, heavy smoking, and nicotine dependence. After controlling for demographics and psychiatric comorbidity, anger experience was uniquely associated with each of these outcomes. Anger experience also was uniquely associated with lifetime history of smoking cessation failure. CONCLUSIONS: Overall, these population-based data suggest an important relationship between problematic anger and numerous aspects of smoking behavior.

A test of the unique and interactive roles of anger experience and expression in suicidality: findings from a population-based study.

This study examined the unique and interactive roles of anger experience and expression in suicidality (suicidal ideation, plans, and attempts) in a large, nationally representative sample. Participants included 5692 adults from the National Comorbidity Survey-Replication, a nationally representative survey. Anger experience was assessed through a continuous measure, whereas anger expression problems were determined by the presence of an intermittent explosive disorder diagnosis. Tests of unique associations revealed that for the overall sample, anger experience and expression each predicted a unique variance in all outcomes of suicidality. Among the individuals reporting lifetime suicidal ideation, anger experience and expression were uniquely related to suicide attempts. Analyses also revealed anger experience and expression to interact in the prediction of suicidal ideation, suggesting that these have independent and additive effects on risk for suicide. The findings suggest that both anger experience and expression contribute to suicidality and the progression from suicidal ideation to plans and attempts.

Priming of courageous behavior: contrast effects in spider fearful women.

OBJECTIVE: Recently, researchers have called for therapeutic applications of behavioral primes (Shalev & Bargh, 2011). We evaluated whether courageous approach behavior might be facilitated through priming in a sample of spider fearful women. METHOD: Undergraduate student women reporting elevated spider fear (N = 33, Age mean = 18.88) were recruited for this study. Participants completed self-report measures of spider fear and dispositional courage. They then completed either a courage or neutral word search prime, which was followed by a behavioral approach task involving a tarantula. RESULTS: Consistent with predictions, among those reporting lower dispositional courage, the courage prime led to reduced approach behavior relative to the neutral prime. However, no group differences were found among those high in dispositional courage. CONCLUSIONS: These findings point to the importance of self-perceptions in moderating the effects of behavioral primes and suggest limitations to the use of such interventions with individuals with psychological dysfunction.

Anger problems across the anxiety disorders: findings from a population-based study.

BACKGROUND: Previous research examining anger problems among the anxiety disorders has been limited by the use of nonrepresentative samples, univariate analyses, as well as low sample size. The current study examined the association between posttraumatic stress disorder (PTSD), panic disorder (PD), social anxiety disorder, specific phobia (SP), and generalized anxiety disorder (GAD) and anger experience and expression. We hypothesized that greater anger experience and expression would be associated with all anxiety disorders, but that it would be most consistently associated with PTSD and PD diagnoses, and that these relationships would remain significant after controlling for demographics (i.e. age, gender, ethnicity, marital status, and income) and comorbid disorders. METHODS: Participants included 5,692 (54% female) adults from the National Comorbidity Survey-Replication, a large, nationally representative survey. RESULTS: Our data suggest that there are unique relationships between multiple anxiety disorders and various indices of anger experience and expression that are not better accounted for by psychiatric comorbidity. Contrary to predictions, PTSD and PD were not consistently associated with anger experience and expression. CONCLUSIONS: Overall, these findings lend support to the emerging literature demonstrating a potentially important relationship between anxiety disorders and anger problems.

Distress tolerance and obsessions: an integrative analysis.

BACKGROUND: Recent research implicates a potential relationship between poor distress tolerance (DT) and obsessive-compulsive disorder (OCD) and obsessions in particular, though this evidence has been largely indirect. We sought to examine the incremental and specific associations between DT and obsessions using multiple methodologies. METHODS: We conducted three separate studies using independent nonclinical samples (total N=558) that involved cross-sectional (Study 1) and prospective self-report designs (Study 2), as well as the use of an in vivo neutralization task (Study 3). RESULTS: Poor DT was specifically associated with obsessing but not other OCD symptoms, even when covarying for several theoretically relevant constructs. Further, poor DT was predictive of residual change in obsessing symptoms 1-month later. Poor DT was also associated with neutralization in response to an OCD-like intrusion and postneutralization period anxiety. CONCLUSIONS: These consistent findings provide support for an important relationship between DT and obsessions and suggest that interventions targeting DT may have special benefit for the treatment of obsessions.

Effect of anger and trait forgiveness on cardiovascular risk in young adult females.

High trait anger is linked to adverse cardiovascular outcomes. A potential antidote to the cardiotoxic influence of anger is trait forgiveness (TF), as it has shown associations with improved blood pressure (BP) and cardiovagal tone regulation in cardiac patients. However, it has yet to be determined if anger and forgiveness independently predict cardiovascular parameters. Trait anger (State-Trait Anger Expression Inventory-2) and TF (Tendency to Forgive Scale) were evaluated in 308 (M = 21.11years ± SD = 2.52) healthy female volunteers allocated to 3 related, yet distinct, studies. Hierarchical multiple regressions tested the incremental contribution of TF after accounting for anger. Study 1 assessed autonomic modulation through beat-to-beat BP and spectral analysis to examine sympathovagal balance and baroreflex functioning. Study 2 used tonometry and pulse wave analysis for aortic hemodynamics. Study 3 assessed 24-hour ambulatory BP and ambulatory arterial stiffness index. Hierarchical models demonstrated that anger was significantly associated with increased sympathovagal tone, increased hemodynamic indices, high ambulatory BPs, and attenuated BP variability and baroreflex. In contrast, TF was associated with more favorable hemodynamic effects (i.e., decreased ventricular work and myocardial oxygen consumption). In conclusion, these results demonstrate divergent cardiovascular effects of anger and forgiveness, such that anger is associated with a more cardiotoxic autonomic and hemodynamic profile, whereas TF is associated with a more cardioprotective profile. These findings suggest that interventions aimed at decreasing anger while increasing forgiveness may be clinically relevant.

Trait hostility and hostile interpretation biases in daily smokers: associations with reasons for smoking, motivation to quit, and early smoking lapse.

Hostility has emerged as an important predictor of smoking cessation difficulties, though the mechanisms underlying the hostility and smoking relationship are poorly understood. Further, research has yet to explore relations between hostile interpretation biases and different aspects of smoking behavior. In the present study, current daily smokers (N = 106) were administered measures of smoking characteristics, smoking motivation, reasons for quitting, hostility, and hostile interpretation bias. Neither trait hostility nor hostile interpretation bias were uniquely associated with motivation to quit, reasons for quitting, nicotine dependence, or problematic symptoms following past cessation attempts. However, hostility and hostile interpretation biases were uniquely associated with different reasons for smoking. Additionally, greater hostile interpretation bias (but not hostility) was uniquely associated with early relapse following past cessation attempts. The current findings add uniquely to the growing, but still relatively small, literature on hostility and smoking and implicate hostile interpretation bias as a potential treatment target in smoking cessation interventions.

An examination of the relationship between anger and suicide risk through the lens of the interpersonal theory of suicide.

Research has implicated a relationship between anger and suicidality, though underlying mechanisms remain unclear. The current study examined this relationship through the lens of the interpersonal theory of suicide (ITS). According to the ITS, individuals who experience thwarted belongingness, perceived burdensomeness, and elevated acquired capability for suicide are at increased risk for death by suicide. The relationships between anger and these variables were examined and these variables were examined as potential mediators between anger and suicidal ideation and behavior. Additionally, exposure to painful and provocative events was examined as a potential mediator between anger and acquired capability. As part of intake at a community mental health clinic, 215 outpatients completed questionnaires assessing depression, suicidal ideation, anger, perceived burdensomeness, thwarted belongingness, and acquired capability. Regression analyses revealed unique relationships between anger and both thwarted belongingness and perceived burdensomeness, covarying for depression. The association between anger and acquired capability trended toward significance. The links between anger and suicidal ideation and behavior were fully mediated by thwarted belongingness and perceived burdensomeness, but this effect was driven by perceived burdensomeness. Additionally, the link between anger and acquired capability was fully mediated by experience with painful and provocative events. In conclusion, results suggest that anger is uniquely associated with perceived burdensomeness and thwarted belongingness. Anger is associated with suicidal ideation and behavior via perceived burdensomeness and with greater acquired capability for suicide via experiences with painful and provocative events. Treatment for problematic anger may be beneficial to decrease risk for suicide.

Effects of interpretation training on hostile attribution bias and reactivity to interpersonal insult.

Research suggests that individuals high in anger have a bias for attributing hostile intentions to ambiguous situations. The current study tested whether this interpretation bias can be altered to influence anger reactivity to an interpersonal insult using a single-session cognitive bias modification program. One hundred thirty-five undergraduate students were randomized to receive positive training, negative training, or a control condition. Anger reactivity to insult was then assessed. Positive training led to significantly greater increases in positive interpretation bias relative to the negative group, though these increases were only marginally greater than the control group. Negative training led to increased negative interpretation bias relative to other groups. During the insult, participants in the positive condition reported less anger than those in the control condition. Observers rated participants in the positive condition as less irritated than those in the negative condition and more amused than the other two conditions. Though mediation of effects via bias modification was not demonstrated, among the positive condition posttraining interpretation bias was correlated with self-reported anger, suggesting that positive training reduced anger reactivity by influencing interpretation biases. Findings suggest that positive interpretation training may be a promising treatment for reducing anger. However, the current study was conducted with a non-treatment-seeking student sample; further research with a treatment-seeking sample with problematic anger is necessary.

The effects of nicotine on intrusive memories in nonsmokers.

Correlational research suggests that smoking increases risk of posttraumatic stress disorder (PTSD), though such research by nature cannot rule out third variable explanations for this relationship. The present study used an analogue trauma film design to experimentally test the effects of nicotine on the occurrence of intrusive memories. Fifty-four healthy nonsmokers were randomly assigned to ingest either a nicotine or placebo lozenge before viewing a film depicting motor vehicle accidents. Participants recorded intrusive memories immediately after the film and for a week via diary. Participants in the nicotine condition reported significantly more intrusive memories immediately after watching the film, yet no group differences emerged on intrusions or intrusion-related distress reported during the following week. Among participants low in dispositional rumination, those who had ingested a nicotine lozenge reported more intrusions in the subsequent week than those in the placebo condition. These findings provide novel experimental evidence for the role of nicotine in increasing risk of PTSD and suggest that nicotine may contribute to trauma-related rumination but not heightened reactivity to trauma cues.

Termination of washing compulsions: a problem of internal reference criteria or 'not just right' experience?

Recent research suggests that obsessive-compulsive washers are more likely than individuals without washing compulsions to use conscious, internal reference criteria when deciding when to terminate compulsions (Wahl, Salkovskis, & Cotter, 2008). An alternative view is that they possess tendencies towards non-cognitive, automatic 'not just right' experiences (NJREs) that influence compulsion duration. The current study sought to investigate the latter explanation using valid behavioral tasks. Non-clinical participants (N=133) completed self-report measures, immersed their hands in a dirt mixture, and afterwards were allowed to wash their hands. Additionally, a subset of participants completed an in vivo assessment of NJRE using a pile of clutter. Total number and intensity of NJREs were predictive of hand-washing duration. Additionally, affective response to the clutter was uniquely predictive of hand-washing duration when controlling for pre-wash anxiety. These results suggest that internal reference criteria as well as NJREs may influence compulsive washing, though the former may be a consequence of the latter.

Posttraumatic stress disorder and cannabis use in a nationally representative sample.

The present study examined the relations between posttraumatic stress disorder (PTSD) and cannabis use in a large representative survey of adults (N = 5,672) from the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (i.e., age, marital status, ethnicity, education, income, and sex), alcohol use disorders, and nicotine dependence, lifetime and current (past year) PTSD diagnoses were associated with increased odds of lifetime history of cannabis use as well as past year daily cannabis use. Lifetime, but not current, PTSD diagnosis also was uniquely associated with increased risk for any past year cannabis use. Additional analyses revealed that the relations between PTSD (lifetime and current) and lifetime cannabis use remained statistically significant when adjusting for co-occurring anxiety and mood disorders and trauma type frequency. Overall, these findings add to the emerging literature demonstrating a possibly important relationship between PTSD and cannabis use.

Comorbid panic attacks among individuals with posttraumatic stress disorder: associations with traumatic event exposure history, symptoms, and impairment.

Little is known about the prevalence of panic attacks in PTSD and their influence on symptom severity and disability. Utilizing the National Comorbidity Survey-Replication data, respondents meeting DSM-IV criteria for past year PTSD (n=203) with and without comorbid panic attacks were compared across various dimensions. Past year panic attacks were found among 35% of the sample and were associated with greater PTSD-related disability and less time spent at work. Panic attacks were also associated with greater prevalence of comorbid depression, substance abuse/dependence, medically unexplained chronic pain, number of anxiety disorders and lifetime traumatic events, PTSD reexperiencing and avoidance/numbing symptoms, and treatment-seeking related to traumatic stress reactions. Multivariate analyses revealed that panic attacks were one of the only unique predictors of severe PTSD-related disability. Overall, findings suggest that panic attacks are common among individuals with PTSD; therapeutic strategies targeting panic in this population may be of significant benefit.