The Metacognitive Processes of Decentering Scale: Development and initial validation of trait and state versions.

The ability to decenter from internal experiences is important for mental health. Consequently, improving decentering is a common therapeutic target, particularly for mindfulness-based interventions. However, extant decentering measures are limited as they fail to directly assess all 3 metacognitive processes recently theorized to subserve decentering. We thus conducted 4 studies to develop and test the Metacognitive Processes of Decentering-Trait (MPoD-t) and State (MPoD-s) scales. Consistent with the metacognitive processes model, exploratory factor analysis (N = 355) and then bifactor exploratory structural equation modeling (N = 275) indicated the MPoD-t was composed of three independent yet interrelated lower-order factors, metaawareness, (dis)identification with internal experience, and (non)reactivity to internal experience, which subserved an emergent, higher-order, decentering factor. We next found evidence of the MPoD-t's convergent validity; as well as known-groups criterion validity, wherein mindfulness practitioners reported higher MPoD-t scores than nonpractitioners. Item response theory analyses were then used to identify a subset of 3 MPoD-t items for the MPoD-s. Finally, we found evidence that the MPoD-s was sensitive to changes in state decentering following a brief mindfulness induction relative to an active control condition; and that MPoD-s changes mediated the effect of mindfulness on levels of pain and related outcomes among a sample of preoperative surgery patients (N = 82). These studies indicate the trait and state versions of the MPoD may prove useful for the study of decentering and its constituent metacognitive processes. As such, the MPoD may help advance our understanding of how the metacognitive processes of decentering support mental health and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Brief mindfulness training de-couples the anxiogenic effects of distress intolerance on reactivity to and recovery from stress among deprived smokers.

OBJECTIVE: We tested whether mindfulness de-couples the expected anxiogenic effects of distress intolerance on psychological and physiological reactivity to and recovery from an anxiogenic stressor among participants experimentally sensitized to experience distress. METHOD: N = 104 daily smokers underwent 18-hours of biochemically-verified smoking deprivation. Participants were then randomized to a 7-min analogue mindfulness intervention (present moment attention and awareness training; PMAA) or a cope-as-usual control condition; and subsequently exposed to a 2.5-min paced over breathing (hyperventilation) stressor designed to elicit acute anxious arousal. Psychological and physiological indices of anxious arousal (Skin Conductance Levels; SCL) as well as emotion (dys)regulation (Respiratory Sinus Arrhythmia; RSA) were measured before, during and following the stressor. RESULTS: We found that PMAA reduced psycho-physiological dysregulation in response to an anxiogenic stressor, as well as moderated the anxiogenic effect of distress intolerance on psychological but not physiological responding to the stressor among smokers pre-disposed to experience distress via deprivation. CONCLUSIONS: The present study findings have a number of theoretical and clinical implications for work on mindfulness mechanisms, distress tolerance, emotion regulation, and smoking cessation interventions.

Nature and role of change in anxiety sensitivity during NRT-aided cognitive-behavioral smoking cessation treatment.

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M (age) = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.

Posttraumatic stress and marijuana use coping motives: the mediating role of distress tolerance.

The present investigation examined the explanatory (i.e,. mediating) role of distress tolerance (DT) in the relation between posttraumatic stress (PTS) symptom severity and marijuana use coping motives. The sample consisted of 142 adults (46.5% women; M(age) = 22.18, SD = 7.22, range = 18-55), who endorsed exposure to at least one Criterion A traumatic life event (DSM-IV-TR, 2000) and reported marijuana use within the past 30 days. As predicted, results demonstrated that DT partially mediated the relation between PTS symptom severity and coping-oriented marijuana use. These preliminary results suggest that DT may be an important cognitive-affective mechanism underlying the PTS-marijuana use coping motives association. Theoretically, trauma-exposed marijuana users with greater PTS symptom severity may use marijuana to cope with negative mood states, at least partially because of a lower perceived capacity to withstand emotional distress.

Distress Tolerance Scale: A Confirmatory Factor Analysis Among Daily Cigarette Smokers.

The present investigation evaluated the factor structure of the Distress Tolerance Scale (DTS; Simons and Gaher 2005) among a sample of 173 (54.9% males) daily cigarette smokers (M=16.64 cigarettes per day, SD=7.83). Comparison of a single higher-order model and a hierarchical multidimensional model was conducted using confirmatory factor analyses (CFA). In addition, evaluation of the internal consistency and convergent and discriminant validity of the better-fitting model was completed. CFA of the DTS indicated a single second-order factor of distress tolerance, and four lower-order factors including Tolerance, Appraisal, Absorption, and Regulation; each factor demonstrated acceptable levels of internal consistency. In addition, the DTS displayed good convergent and discriminant validity with theoretically relevant smoking and affect variables. Results are discussed in terms of explicating the latent structure of distress tolerance, as measured by the DTS, within the context of smoking research.

Posttraumatic stress symptoms and cigarette deprivation in the prediction of anxious responding among trauma-exposed smokers: a laboratory test.

INTRODUCTION: The present investigation examined the main and interactive effects of posttraumatic stress symptom severity and 12-hr cigarette deprivation (cf. smoking as usual) in the prediction of anxious responding during a 4-min 10% carbon dioxide (CO2)-enriched air laboratory challenge. It was hypothesized that 12-hr cigarette deprivation would exacerbate the effects of posttraumatic stress symptom severity with regard to anxious responding during the challenge. METHODS: Participants were 63 daily smokers (46.0% women; M(age) = 30.79, SD = 13.12, range = 18-60) who reported experiencing one or more traumatic events. The study consisted of two laboratory sessions. At the first session, participants were administered a structured diagnostic interview and completed self-reported measures. Eligible participants were randomly assigned to one of two conditions for the second session: (a) 12-hr cigarette deprivation or (b) noncigarette deprivation (i.e., smoking as usual). At the second session, participants' smoking status was biochemically verified, and all eligible participants then were administered the 10% CO2-enriched air laboratory challenge protocol. RESULTS: The main and interactive effects of posttraumatic stress symptom severity and the smoking-as-usual condition--not the hypothesized 12-hr cigarette deprivation condition--were significantly predictive of peri-challenge anxiety. The interactive effect of posttraumatic stress by smoking as usual was significant at Minutes 3 and 4 of the challenge specifically. CONCLUSIONS: The present investigation provided novel findings related to the roles of cigarette deprivation and smoking with regard to self-reported anxious responding, among trauma-exposed smokers, during a challenge paradigm.

Premenstrual distress predicts panic-relevant responding to a CO2 challenge among young adult females.

The current study examined the incremental validity of self-reported premenstrual distress in predicting panic responsivity (self-reported panic symptoms and skin conductance response frequency; SCR) following inhalation of 10% CO(2)-enriched air. A community sample of young adult women (n=46) completed questionnaires assessing substance use patterns, premenstrual symptoms and distress, and anxiety sensitivity and underwent a laboratory biological challenge procedure (4-min 10% CO(2)-enriched air inhalation). As hypothesized, higher premenstrual distress scores significantly predicted greater self-reported panic symptoms following the CO(2) challenge above and beyond other theoretically relevant variables (anxiety sensitivity, cigarette use, and alcohol consumption). In predicting SCR, premenstrual distress exhibited only a trend towards statistical significance. These findings provide preliminary evidence that premenstrual symptoms may serve as a potential risk factor to experience more intense panic symptoms in response to perturbations in bodily sensations.

Relations between anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations to coping and conformity marijuana use motives among young adult marijuana users.

The present investigation examines anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations in relation to Coping and Conformity marijuana use motives among a sample of young adult marijuana users (n = 135; 46.7% women; Mage = 20.45, SD = 5.0). After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, average volume of alcohol used over the past year, negative affectivity, and other marijuana use motives, anxiety sensitivity was significantly and uniquely associated with Coping and Conformity motives for marijuana use. Distress tolerance evidenced significant and unique incremental relations to Coping motives, whereas fear reactivity to bodily sensations was unrelated to any marijuana use motive. These results provide novel information related to the role of emotional sensitivity and tolerance factors as they pertain to specific types of motives for marijuana use among young adults.

Evaluation of anxiety sensitivity among daily adult smokers using item response theory analysis.

The present investigation applied Item Response Theory (IRT) methodology to the 16-item Anxiety Sensitivity Index (ASI) [Reiss, S., Peterson, R. A., Gursky, M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8] for a sample of 475 daily adult smokers (52% women; M(age)=26.9, S.D.=11.1, range=18-65). Using non-parametric item response analysis, all 16 ASI items were evaluated. Evaluation of the option characteristic curves for each item revealed 4 poorly discriminating ASI items (1: "It is important not to appear nervous;" 5: "It is important to me to stay in control of my emotions;" 7: "It embarrasses me when my stomach growls;" 9: "When I notice my heart beating rapidly, I worry that I might be having a heart attack"), which were dropped from analysis. Upon repeat analysis, the remaining items appeared to make adequate separations within levels of anxiety sensitivity in this sample. Graded response modeling data indicated important differences in ASI items' capacity to discriminate between, and provide information about, latent levels of anxiety sensitivity. Specifically, three items best discriminated and provided the most information regarding latent levels of AS-items 3, 15, and 16. Items 1, 5, 7, and 9 were omitted due to their limited capacity to discriminate between latent levels of anxiety sensitivity; items 8, 12, and 13 also performed poorly. Overall, current findings suggest that evaluation of anxiety sensitivity among adult smokers using the 16-item ASI may usefully choose to focus on items that performed well in these IRT analyses (items: 2, 3, 4, 6, 10, 11, 14, 15, and 16).

Impact of Posttraumatic Stress Disorder on early smoking lapse and relapse during a self-guided quit attempt among community-recruited daily smokers.

The present investigation examined whether daily smokers with posttraumatic stress disorder (PTSD), as compared to daily smokers with either anxiety psychopathology or no current Axis I psychopathology, have decreased success in the early phases of a self-guided smoking quit attempt. Participants were 140 daily smokers (81 women; M (age) = 29.5; SD = 11.9; range = 18-65 years); approximately one-third of the sample met criteria for current PTSD (n = 47), one-third met criteria for other current anxiety disorders (without PTSD; n = 33), and one-third did not meet criteria for any current Axis I disorder (n = 60). Consistent with prediction, membership in the PTSD group, compared to membership in the other anxiety disorders group and the group with no current Axis I psychopathology, was associated with increased risk of lapse during the first week following quit day. Additionally, daily smokers with PTSD and other anxiety disorders were at significantly increased risk of relapse during the first week post-cessation compared to persons without Axis I psychopathology. However, the PTSD group and the other anxiety disorders group did not differ from one another in terms of relapse. Results suggest that PTSD is associated with increased risk of smoking lapse and relapse compared to smokers with no current Axis I psychiatric problems, and increased risk of early smoking lapse but not relapse, as compared to those with other anxiety disorders. Findings provide novel evidence that PTSD, and perhaps anxiety disorders more generally, may be important factors in reducing the odds of successful unaided quit attempts in the early phases of cessation.

Anxiety sensitivity and smoking motives and outcome expectancies among adult daily smokers: replication and extension.

The present investigation examined the incremental validity of anxiety sensitivity in the context of distress intolerance in terms of predicting smoking motives and outcome expectancies. Participants were a community sample of 144 daily smokers (85 women, M (age) = 29.72 years, SD = 11.96). Results indicated that above and beyond discomfort intolerance, Axis I diagnoses, gender, volume of alcohol consumption, and average number of cigarettes smoked per day, anxiety sensitivity significantly incrementally predicted habitual, addictive, and negative affect reduction motives to smoke, as well as negative reinforcement outcome expectancies. No such incremental effects were similarly evident for distress intolerance. Findings are discussed in relation to the role of anxiety sensitivity in smoking motives and outcome expectancies.

Anxiety sensitivity and perceived control over anxiety-related events: associations with smoking outcome expectancies and perceived cessation barriers among daily smokers.

The present investigation examined the extent to which the cognitive factors of anxiety sensitivity (AS) and perceived control over anxiety-related events are independently related to smoking outcome expectancies and perceived barriers to quitting. Participants were 125 community-recruited adult, daily smokers. Consistent with hypotheses, AS and perceived control over anxiety-related events independently and significantly predicted smokers' expectancies for negative affect reduction from smoking, whereas only AS predicted expectancies for negative personal consequences from smoking. Also as hypothesized, AS and perceived control over anxiety-related events each independently and significantly predicted level of general perceived barriers to quitting smoking. All of the observed significant effects were evident above and beyond the variance accounted for by gender, alcohol consumption, number of cigarettes smoked per day, and negative affectivity. Together, these findings further the literature on the relation between anxiety-relevant cognitive factors and psychological smoking processes.

Negative reinforcement/negative affect reduction cigarette smoking outcome expectancies: incremental validity for anxiety focused on bodily sensations and panic attack symptoms among daily smokers.

The present investigation evaluated the incremental validity of negative reinforcement/negative affect reduction smoking outcome expectancies in the prediction of anxious and fearful responding to bodily sensations. Participants included 171 daily smokers (82 women, 89 men; mean age = 25.67 years, SD = 10.54). Consistent with prediction, negative reinforcement/negative affect reduction smoking outcome expectancies were significantly predictive of anxiety focused on bodily sensations and postchallenge intensity of cognitive panic attack symptoms, but not of physical panic symptoms. The observed effects were evident above and beyond the statistically significant variance accounted for by the covariates of anxiety sensitivity, negative affectivity, cigarettes per day, and weekly alcohol use and independent of other smoking outcome expectancy factors. Findings are discussed in terms of the role of negative reinforcement/negative affect reduction smoking outcome expectancies and vulnerability for panic symptoms and psychopathology.

Evaluation of smoking characteristics among community-recruited daily smokers with and without posttraumatic stress disorder and panic psychopathology.

The present investigation compared 123 community-recruited daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), nonclinical panic attacks (PA), or no current Axis I psychopathology (controls; C) in terms of nicotine dependence, smoking rate, quit history, severity of symptoms during past quit attempts, and motivation for and expectancies about smoking. No differences were observed between groups in regard to smoking rate or nicotine dependence. The PTSD group reported making more lifetime quit attempts than the other groups, and the PTSD and PD groups perceived more severe symptoms during past quit attempts. The PD and PTSD groups reported greater motivation to smoke to reduce negative affect. Individuals with PTSD endorsed a stronger expectation that smoking would alleviate negative mood states and would produce negative consequences. Overall, results suggest that smokers with PD or PTSD differ from other smoking groups in a number of clinically significant ways.

Prospective associations between cannabis use, abuse, and dependence and panic attacks and disorder.

The present study prospectively evaluated cannabis use, abuse, and dependence in relation to the development of panic attacks and panic disorder. Participants at the start of the study were adolescents (n=1709) with a mean age of 16.6 years (SD=1.2; time 1) and were re-assessed 1 year later (time 2) and then again as young adults (time 3; mean age=24.2 years, SD=0.6). Results indicated that cannabis use and dependence were significantly prospectively associated with an increased odds for the development of panic attacks and panic disorder. However, cannabis was not incrementally associated with the development of panic after controlling for daily cigarette smoking. The theoretical and clinical implications of these findings are discussed.

Marijuana coping motives interact with marijuana use frequency to predict anxious arousal, panic related catastrophic thinking, and worry among current marijuana users.

The present investigation evaluated whether coping motives for marijuana use interacted with past 30-day frequency of marijuana use in relation to anxiety-relevant variables among community-recruited young adult marijuana users (n=149). As expected, after covarying cigarettes per day, alcohol use, and total years of marijuana use, the interaction between frequency of past 30-day marijuana use and coping motives predicted anxious arousal symptoms, agoraphobic cognitions, and worry. Marijuana users who demonstrated high use frequency and high coping motives demonstrated the highest levels of anxiety across these anxiety-relevant criterion variables. No such effects were evident, as expected, for depressive symptoms, offering explanatory specificity for anxiety relative to depressive factors. These results are discussed in relation to better understanding the role of marijuana use and coping motives in regard to anxiety vulnerability.

Incremental validity of anxiety sensitivity in terms of motivation to quit, reasons for quitting, and barriers to quitting among community-recruited daily smokers.

The present investigation examined the relationships between anxiety sensitivity and motivation to quit smoking, barriers to smoking cessation, and reasons for quitting smoking among 329 adult daily smokers (160 females; M (age) = 26.08 years, SD = 10.92). As expected, after covarying for the theoretically relevant variables of negative affectivity, gender, Axis I psychopathology, nonclinical panic attack history, number of cigarettes smoked per day, and current levels of alcohol consumption, we found that anxiety sensitivity was significantly incrementally related to level of motivation to quit smoking as well as current barriers to quitting smoking. Partially consistent with the hypotheses, after accounting for the variance explained by other theoretically relevant variables, we found that anxiety sensitivity was significantly associated with self-control reasons for quitting smoking (intrinsic factors) as well as immediate reinforcement and social influence reasons for quitting (extrinsic factors). Results are discussed in relation to better understanding the role of anxiety sensitivity in psychological processes associated with smoking cessation.

Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event-exposed marijuana users.

The present study examines the relation between posttraumatic stress symptom severity and motives for marijuana use among 103 (55 women) young adult marijuana users (current) who reported experiencing at least one traumatic event in their lifetime. As expected, after covarying for the theoretically relevant variables of frequency of past 30-day marijuana use, number of cigarettes smoked per day, and volume of alcohol consumed, posttraumatic stress symptom severity was significantly related to marijuana use coping motives, but no other motives for marijuana use. Results are discussed in relation to better understanding the role of coping-motivated marijuana use among young adults experiencing posttraumatic stress.

Marijuana use motives: A confirmatory test and evaluation among young adult marijuana users.

The present investigation evaluated the measurement model and construct validity of marijuana use motives as measured by the Marijuana Motives Measure (MMM; [Simons, J., Correia, C. J., Carey, K. B., and Borsari, B. E. (1998). Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology, 45, 265-273]). Confirmatory factor analysis (CFA) and incremental tests of validity of marijuana use motives were conducted on a sample of young adult marijuana users (n=227, 127 women; M(age)=20.11, SD=4.30 years). As hypothesized, CFA analysis of marijuana use motives, as indexed by the MMM, demonstrated support for a multidimensional measurement model; specifically, a five-factor solution denoting Enhancement, Conformity, Expansion, Coping, and Social motives for marijuana use, each with satisfactory levels of internal consistency. Subsequent tests of incremental validity suggested that only certain motives were uniquely related to current substance use and cognitive-affective factors. Results are discussed in relation to refining the scientific understanding of marijuana use motives.