Effects of safety behavior fading on social anxiety and emotional disclosure.

Individuals with social anxiety disorder commonly engage in safety behaviors (SBs), which are behavioral and cognitive strategies employed in an effort to avoid or decrease the likelihood of a feared threat outcome and decrease anxiety in social situations. These behaviors are thought to be dysfunctional and play a key role in contemporary models of the disorder. The current experimental study sought to expand upon existing research by examining the role of SBs in social anxiety and self-disclosure. Participants with elevated social anxiety symptoms (N = 115) were randomized to either a two-week SB fading manipulation or a no-instruction control. Self-report measures were administered pre- and post-manipulation, and participants completed an in-vivo speech task at post. SB fading led to lower social anxiety symptoms at post relative to the control. SB fading also led to greater self-reported openness to general self-disclosure and emotional disclosure compared to the control, though these effects were modest. No condition effect on emotional reactivity to a speech task was observed. SB fading led to greater observer-rated disclosure on the speech task than control, though this was only found among those high in dispositional self-disclosure at baseline. The present study provides further evidence for the importance of SBs in social anxiety and suggests SB fading might lead to greater comfort with self-disclosure. Limitations and directions for future research are discussed.

Exaggerated interpretation bias for uncertain information as a predictor of anxiety-related symptoms: A new method of assessment for IU.

BACKGROUND AND OBJECTIVES: Intolerance of uncertainty (IU), or fear of the unknown, is as an important transdiagnostic risk factor across anxiety-related conditions, namely generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), and social anxiety disorder (SAD). IU is typically indexed using self-report measures. Given the importance of multi-method assessments and the shortcomings associated with existing behavioral indices of IU, additional methods of assessment are needed. Emerging literature supports the use of interpretation bias (IB) paradigms to index constructs such as IU. However, only one study to date has examined the association between an IU-focused IB paradigm (IU-IB) and self-report IU and no research has investigated whether an IU-IB paradigm would be related to increased anxiety-related symptoms. METHODS: The current investigation examined the utility of an IU-IB paradigm across two separate samples wherein participants completed an interpretation bias task and self-report measures. Sample 1 included 86 participants (74.4% female; Mage = 19.14) and sample 2 included 138 participants (79.7% female; Mage = 18.88). RESULTS: Findings from Study 1 indicated a significant association between an exaggerated IU-IB and symptoms of GAD and OCD, and this relationship held after covarying for negative affect. Study 2 results indicated a significant relationship between an exaggerated IU-IB and symptoms of GAD, OCD, and SAD, after covarying for negative affect. LIMITATIONS: The current study had a variety of limitations, including the use of cross-sectional data and an undergraduate sample. CONCLUSIONS: These findings provide an important replication and extension of previous work and highlight the transdiagnostic utility of this IU-IB task.

Interactive effects of cumulative lifetime traumatic brain injuries and combat exposure on posttraumatic stress among deployed military personnel.

Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual's lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist - Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.

Distress tolerance as a mechanism of PTSD symptom change: Evidence for mediation in a treatment-seeking sample.

Low distress tolerance, the perceived or actual inability to tolerate negative emotional states, is a transdiagnostic risk marker associated with greater PTSD symptoms and poorer treatment outcomes. However, the role of distress tolerance in PTSD symptom trajectories has not yet been explored. This study examined the mediating role of distress tolerance in PTSD symptom change among outpatients participating in a trial of computerized interventions for anxiety-related and mood-related risk factors. It was hypothesized that pre- to post-intervention change in distress tolerance would predict PTSD symptoms at three- and six-month follow-up, and mediate the effect of condition on PTSD symptoms above and beyond the effects of a competing mediator, anxiety sensitivity. Although condition differences in distress tolerance change were non-significant, distress tolerance change predicted month-three PTSD symptoms and mediated the direct effect of condition on month-three PTSD symptoms. After accounting for the direct effect of condition on month-six PTSD symptoms, distress tolerance change did not predict month-six PTSD symptoms. Findings suggest distress tolerance does play a longitudinal role in PTSD symptom change, and distress tolerance interventions may benefit certain samples who may otherwise not be able to immediately access, or remain in PTSD treatments.

Effect of concussion and blast exposure on symptoms after military deployment.

OBJECTIVE: To examine whether blast exposure alone and blast-associated concussion result in similar neurologic and mental health symptoms. METHODS: A 14-item questionnaire was administered to male US Marines on their return from deployment in Iraq and/or Afghanistan. RESULTS: A total of 2,612 Marines (median age 22 years) completed the survey. Of those, 2,320 (88.9%) reported exposure to ≥1 blast during their current and/or prior deployments. In addition, 1,022 (39.1%) reported ≥1 concussion during the current deployment, and 731 (28.0%) had experienced at least 1 prior lifetime concussion. Marines were more likely to have sustained a concussion during the current deployment if they had a history of 1 (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-2.0) or ≥1 (OR 2.3, 95% CI 1.7-3.0) prior concussion. The most common symptoms were trouble sleeping (38.4%), irritability (37.9%), tinnitus (33.8%), and headaches (33.3%). Compared to those experiencing blast exposure without injury, Marines either experiencing a concussion during the current deployment or being moved or injured by a blast had an increased risk of postinjury symptoms. CONCLUSIONS: There appears to be a continuum of increasing total symptoms from no exposure to blast exposure plus both current deployment concussion and past concussion. Concussion had a greater influence than blast exposure alone on the presence of postdeployment symptoms. A high blast injury score can be used to triage those exposed to explosive blasts for evaluation.

Posttraumatic stress disorder and suicidal ideation, plans, and impulses: The mediating role of anxiety sensitivity cognitive concerns among veterans.

BACKGROUND: Although the relationship between posttraumatic stress disorder (PTSD) and suicide has been firmly established, research on underlying mechanisms has been disproportionately low. The cognitive concerns subscale of anxiety sensitivity (AS), which reflects fears of cognitive dyscontrol, has been linked to both PTSD and suicide and thus may serve as an explanatory mechanism between these constructs. METHODS: The sample consisted of 60 male veterans presenting to an outpatient Veteran Affairs (VA) clinic for psychological services. Upon intake, veterans completed a diagnostic interview and brief battery of self-report questionnaires to assist with differential diagnosis and treatment planning. RESULTS: Results revealed a significant association between PTSD symptom severity and higher suicidality (i.e., ideation, plans, and impulses), even after accounting for relevant demographic and psychological constructs. Moreover, AS cognitive concerns mediated this association. LIMITATIONS: Limitations include the small sample size and cross-sectional nature of the current study. CONCLUSIONS: These findings add considerably to a growing body of literature examining underlying mechanisms that may help to explain the robust associations between PTSD and suicide. Considering the malleable nature of AS cognitive concerns, research is needed to determine the extent to which reductions in this cognitive risk factor are associated with reductions in suicide among at risk samples, such as those included in the present investigation.