Anxiety Sensitivity Among Trauma-Exposed Non-Hispanic Black Adults: Relations to Posttraumatic Stress.

ABSTRACT: The non-Hispanic Black population experiences trauma-related disparities. One potentially important individual difference construct for posttraumatic stress is anxiety sensitivity. There is limited work on anxiety sensitivity among non-Hispanic Black persons, and no research has focused on this construct in terms of posttraumatic stress among this population. This study sought to build on this limited knowledge by exploring whether this construct was uniquely associated with more severe posttraumatic stress among this population. Participants included non-Hispanic Black trauma-exposed adults ( N = 121; Mage = 21.79 years). Results indicated that anxiety sensitivity was related to more severe overall posttraumatic stress and greater severity of each posttraumatic stress symptom cluster; all effects were evident after adjusting for the variance accounted for by age, sex, education, subjective social status, neuroticism, and number of traumatic event types experienced (lifetime). The study provides the first empirical evidence that, among a trauma-exposed non-Hispanic Black sample of adults, anxiety sensitivity is related to more severe posttraumatic stress symptoms. This intraindividual difference factor could be a focus of intervention programming for this trauma disparity population.

Indirect Effects of Negative Mood on Opioid Misuse and Dependence via Anxiety Sensitivity Subfacets: Evidence from Adults Reporting Chronic Pain.

Background: Opioid misuse in the context of pain management exacts a significant public health burden. Past work has established linkages between negative mood (i.e., symptoms of anxiety and depression) and opioid misuse/dependence, yet the mechanisms underlying these associations have received little scientific investigation. Anxiety sensitivity (AS), the fear of the negative consequences of internal states, may be relevant to better understanding negative mood-opioid relations among adults with chronic pain. Methods: Simultaneous indirect effects of negative mood on opioid misuse and opioid dependence via lower-order factors of AS (physical, cognitive, and social concerns) were examined cross-sectionally in the present study. The study sample consisted of 428 adults (74.1% female, Mage = 38.27 years, SD = 11.06) who self-reported current moderate to severe chronic pain and opioid use for chronic pain. Results: Results indicated that negative mood was (in part) indirectly related to opioid misuse (in part) via AS physical and cognitive concerns and was (in part) indirectly related to opioid dependence via AS cognitive concerns only. No significant indirect effects via social concerns were observed. Discussion and Conclusions: Findings suggest the importance of further exploring the role of anxiety sensitivity cognitive and physical concerns in terms of opioid misuse and dependence among adults with chronic pain.

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.

Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers.

Cigarette smoking is associated with adverse physical and mental health among Latinx adults in the United States. The present investigation sought to explore the main and interactive effects of anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation, and severity of problems experienced when quitting among adult Latinx smokers. Participants included 338 Latinx adult daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that anxiety symptoms were associated with greater cigarette dependence, severity of problems when quitting, and perceived barriers for smoking cessation (effect size range: 2%-3% of variance), whereas anxiety sensitivity was related to severity of problems when quitting and perceived barriers for smoking cessation (effect size range: 2%-3% of variance). There was also a statistically significant interaction between anxiety sensitivity and anxiety symptoms for cigarette dependence; anxiety was related to cigarette dependence for Latinx smokers with higher levels of anxiety sensitivity, but not for those with lower levels of anxiety sensitivity. Overall, the present findings indicate that anxiety symptoms and anxiety sensitivity are relevant factors for better understanding cigarette dependence, problems experienced when trying to quit, and perceptions of barriers to quitting among adult Latinx smokers.

Anxiety sensitivity and modifiable cardiovascular disease risk factors: the role of pain intensity among individuals with chronic pain.

Chronic pain is often comorbid with modifiable cardiovascular disease risk factors, such as obesity and tobacco use. Among individuals with chronic pain, psychological risk factors may increase pain which, in turn, may increase risk for modifiable cardiovascular disease correlates. Thus, the current study examined the explanatory role of pain intensity in the relationship between anxiety sensitivity and two well-documented modifiable cardiovascular disease risk factors. Participants included 396 adults with chronic pain who completed an online survey from a larger study examining chronic pain-mental health relations. Results revealed that higher levels of anxiety sensitivity were related to higher levels of body mass index (BMI) through greater levels of pain intensity. Bi-directional relations were observed between anxiety sensitivity and pain intensity for tobacco risk. The current study highlights a potential transdiagnostic cognitive vulnerability factor, anxiety sensitivity, which may be an important treatment target to reduce modifiable cardiovascular disease risk factors via reductions in pain intensity.

COVID-related stress and substance use: examining the role of sleep disturbance.

The current investigation employed a cross-sectional design to evaluate the associations of COVID-19 stress, sleep disturbance, and substance use among a national sample of 143 adults (57.3% male, Mage = 38.5 years, SD = 11.28), surveyed at a single time-point using Amazon's MTurk platform. We hypothesized that COVID-19-related stress would be indirectly related to substance use outcomes (i.e. number of substance classes used daily, number of alcoholic drinks per occasion, substance use coping motives; but not substance use enhancement motives) through sleep disturbance severity. As expected, results indicated that the models examining indirect effects were statistically significant for number of substance classes used daily and substance use coping motives. However, there was no evidence that sleep disturbance explained the relation between COVID-19-related stress and number of alcoholic drinks per occasion or substance use enhancement motives. These findings underscore the importance of sleep disturbance in efforts to better understand how COVID-19-related stress is associated with certain types of substance use behavior.

Anxiety and depressive symptoms among adults with obesity and chronic pain: the role of anxiety sensitivity.

Obesity and chronic pain frequently co-occur, and this co-occurrence can have potential negative consequences, particularly as it relates to mental health. As such, there is a need to understand potential risk factors for poor mental health among this co-morbid population. Thus, the current study examined the predictive role of anxiety sensitivity (and its sub-facets) on anxiety and depressive symptoms among adults (82.5% female, Mage = 40.2 years, SD = 10.92) with obesity and chronic pain. Results revealed that greater levels of anxiety sensitivity were associated with greater levels of both anxiety and depressive symptoms, with medium to large effect sizes. Post hoc analyses also indicated that specific sub-facets of anxiety sensitivity (cognitive and social concerns) were significant predictors of the criterion variables. The current study highlights the potential clinical utility in targeting anxiety sensitivity among individuals with co-occurring obesity and chronic pain in the treatment of anxiety and depressive symptoms.

Computer-delivered intervention for individuals with obesity and elevated anxiety sensitivity: feasibility, acceptability, and initial test.

Obesity is one the fastest growing public health problems related to numerous chronic diseases and frequently co-occurs with negative mood states. One promising approach to address the heterogeneity of affective vulnerabilities and obesity is to focus on processes (e.g. anxiety sensitivity [AS]) that underpin both conditions. Thus, this study aimed to evaluate the feasibility, acceptability, and initial efficacy of a brief, computer-delivered AS reduction program (AST) for adults with obesity and elevated AS. Participants were 131 individuals with obesity and elevated AS who received either AST or a health information control (HC). Latent growth curve modeling was utilized to examine the effect of treatment condition on change in AS, emotional eating, expectancies of eating to manage mood, and exercise self-efficacy from baseline to 1-week, 2-weeks, and 1-month follow-up. Results indicated it was feasible to recruit and retain individuals with obesity and elevated AS through the 1-month follow-up. Positive qualitative feedback was also provided for both AST and HC. AST was a statistically significant predictor of change in expectancies of eating to manage negative affect. No other statistically significant treatment effects were indicated. Current data provide initial empirical support for future work focused on persons with obesity and elevated AS.

Fatigue severity and fatigue sensitivity: relations to anxiety, depression, pain catastrophizing, and pain severity among adults with severe fatigue and chronic low back pain.

Chronic low back pain is the second leading cause of disability in the United States, and it is often associated with severe fatigue. However, little is known about individual differences that may be related to poorer mental health and pain among individuals with severe fatigue and chronic low back pain. The aim of the current investigation was to explore the role of fatigue severity and fatigue sensitivity in terms of anxiety and depressive symptoms, pain catastrophizing, pain interference, and pain severity among 783 adults with severe fatigue and chronic low back pain. Results suggest that fatigue severity and fatigue sensitivity were statistically significant predictors for anxiety, depression, pain interference, and pain catastrophizing. However, only fatigue sensitivity significantly predicted pain severity. Overall, the current study provides initial support for the role of fatigue severity and fatigue sensitivity in the presence of mental and physical health complaints among individuals with severe fatigue and chronic low back pain.

Pain-Related Anxiety among Adults with Obesity and Chronic Pain: Relations with Pain, Opioid Misuse, and Mental Health.

Obesity affect a significant proportion of the population in the United States, and is associated with numerous health consequences including anxiety, depression, and chronic pain. Additionally, pain among adults with obesity has been associated with greater mental health problems and substance use problems. Yet little work has examined psychological vulnerability factors associated with these relations, and pain-related anxiety may be one candidate psychological correlate of these relations. Therefore, the current study examined the association of pain-related anxiety with pain intensity, disability, opioid misuse, anxiety, and depression among 164 adults (81.7% female, Mage = 40.13 years, SD = 10.85) with obesity (MBMI= 37.21, SD = 6.70) and chronic pain. Results suggested that pain-related anxiety was significantly associated with all outcomes, and these results suggest that pain-related anxiety may play an important role in physical health, mental health, and substance use outcomes among adults with obesity and chronic pain.

Financial strain among adult African American/Black cannabis users.

African American/Black persons belong to the second largest racial/ethnic minority group in the United States. This group evinces significant disparities related to cannabis use problems. Social determinants of health may be potentially relevant to better understand cannabis use problems among African American/Black adults. As such, the current study sought to provide an initial test of the role of financial strain, a prominent social determinant of health, in cannabis use problems and perceived barriers for cannabis cessation among African American/Black adults. Participants were 76 (32.9% female, Mage = 38.64, SD = 10.82) African American/Black adult, current cannabis users. Hierarchical regression results indicated that greater financial strain was associated with more cannabis use problems and greater perceived barriers for cannabis cessation; such effects were evident above and beyond the variance explained by a range of relevant covariates, including age, sex, income, education, and depressive symptoms. These findings suggest addressing financial strain (e.g., financial planning, psychoeducation about the handling financial stress) may be a useful therapeutic tactic in the larger landscape of treatment programming when targeting cannabis use behaviors and beliefs among African American/Black adult cannabis users.

The Role of Anxiety Sensitivity and Fatigue Severity in Predicting E-Cigarette Dependence, Barriers to Cessation, and Cravings among Young Adults.

Background: Electronic cigarette (e-cigarette) use has risen dramatically in the United States among young adults; however, little is understood about potential factors that are related to e-cigarette use and maintenance among this population. Fatigue severity is one promising individual difference factor, as past work indicates that it is related to greater withdrawal symptoms and greater dependence on e-cigarettes, and more barriers to quitting. In addition, anxiety sensitivity and severe fatigue are both uniquely related to poor e-cigarette use outcomes; yet, no known studies have examined whether these individual difference factors are related to e-cigarette outcomes among young adults. Method: The current study sought to examine the unique and interactive effects of anxiety sensitivity and fatigue severity in predicting a variety of e-cigarette outcomes among 685 (69.1% female; Mage = 19.61 years, SD = 1.44) young adult e-cigarette users. Results: Results indicated that anxiety sensitivity was significantly associated with greater barriers for cessation (ß = .63, p <.001) and e-cigarette cravings (ß = .67, p =.001), but not dependence. Fatigue severity was significantly associated with greater e-cigarette dependence (ß = .58, p <.001), barriers to cessation (ß = 1.56, p <.001), and e-cigarette cravings (ß = 3.34, p <.001). The interactive effects of anxiety sensitivity and fatigue severity did not significantly predict the outcomes. Discussion: Results suggest that anxiety sensitivity and fatigue severity independently predict greater e-cigarette maintenance factors among young adults. The current investigation highlights the importance of targeting anxiety sensitivity and fatigue severity among young adult e-cigarette users.

Pain intensity, pain-related anxiety, and somatic and mental health symptoms: a test among latinx young adults.

Latinx individuals demonstrate significant pain-related health disparities compared to other racial/ethnic groups. Moreover, young adulthood (18-25 years of age) is a primary developmental window wherein pain-related health problems are first encountered and may be related to more severe somatic and mental health symptoms. Pain-related anxiety may be one mechanistic construct linking individual differences in the experience of pain intensity to poorer somatic experiences and mental health among Latinx young adults. Thus, the current study examined pain-related anxiety as an explanatory factor underlying the relationship between pain intensity and body vigilance, perceptions of health, worry, anxious arousal, and depressive symptoms among Latinx young adults. Participants included 401 Latinx young adults (Mage = 21 years; SD = 2.02; age range: 18-25 years; 83% female) at a large, southwestern university. Results revealed that individual differences in pain intensity had a significant indirect effect on the studied somatic and negative affect variables through pain-related anxiety. These novel findings suggest future work should continue to explore pain-related anxiety in the association between the experience of pain and somatic and mental health among Latinx young adults.

The Role of Anxiety Sensitivity in the Relation Between Pain Intensity with Substance Use and Anxiety and Depressive Symptoms Among Smokers with Chronic Pain.

BACKGROUND: The additive effect of experiencing chronic pain in the context of nicotine addiction places smokers with chronic pain at elevated risk for experiencing physical and mental health problems. Isolating factors that explain linkages between pain and health-related outcomes among smokers with chronic pain is an important next step. Therefore, the current study examined the explanatory role of anxiety sensitivity in relations between pain intensity and current opioid misuse, severity of opioid dependence, tobacco-related problems, and anxiety/depressive symptoms. METHOD: Participants were 187 (Mage = 39.02, SD = 9.94, 74.9% female) daily smokers with chronic pain who completed a battery of self-report measures on pain experience, anxiety sensitivity, tobacco and opioid use, and anxiety/depression symptoms. Indirect effect analyses were conducted to examine anxiety sensitivity as a mediator of the relations between pain intensity and health-related outcomes. RESULTS: A significant indirect effect emerged for pain intensity, through anxiety sensitivity, on opioid misuse (ab = 0.83, SE = 0.24, 95% CI [0.39, 1.34], CSE = 0.17), severity of opioid dependence (ab = 0.17, SE = 0.05, 95% CI [0.08, 0.26], CSE = 0.16), tobacco use problems (ab = 0.16, SE = 0.06, 95% CI [0.07, 0.28], CSE = 0.11), and anxiety/depressive symptoms (ab = 0.20, SE = 0.06, 95% CI [0.10, 0.31], CSE = 0.19). CONCLUSION: The current investigation highlights the potential importance of anxiety sensitivity in terms of the experience of pain with severity of substance use and anxiety/depressive symptoms among smokers with chronic pain.

Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials.

The purpose of this meta-analysis was to provide updated pooled effect sizes of evidence-based psychotherapies and medications for generalized anxiety disorder (GAD) and to investigate potential moderators of outcomes. Seventy-nine randomized controlled trials (RCT) including 11,002 participants with a diagnosis of GAD were included in a meta-analysis that tested the efficacy of psychotherapies or medications for GAD. Psychotherapy showed a medium to large effect size (g = 0.76) and medication showed a small effect size (g = 0.38) on GAD outcomes. Psychotherapy also showed a medium effect on depression outcomes (g = 0.64) as did medications (g = 0.59). Younger age was associated with a larger effect size for psychotherapy (p < 0.05). There was evidence of publication bias in psychotherapy studies. This analysis found a medium to large effect for empirically supported psychotherapy interventions on GAD outcomes and a small effect for medications on GAD outcomes. Both groups showed a medium effect on depression outcomes. Because medication studies had more placebo control conditions than inactive conditions compared to psychotherapy studies, effect sizes between the domains should not be compared directly. Patient age should be further investigated as a potential moderator in psychotherapy outcomes in GAD.

Anxiety sensitivity and opioid misuse among opioid-using adults with chronic pain.

Background: The opioid epidemic is a significant public health crisis, and this problem is particularly prevalent among individuals with chronic pain. Accordingly, there is an urgent need for interventions to mitigate the risk for opioid misuse and opioid use disorder among people with pain. Given that mental health problems, specifically anxiety, are common among people who misuse opioids, it is important to examine factors that link mental health problems with opioid misuse to ultimately inform the development of novel interventions. Anxiety sensitivity, a transdiagnostic vulnerability factor defined as the fear of anxiety-related physical sensations, may be one important mechanism in elevated opioid misuse among persons with chronic pain. Objective: Therefore, the current cross-sectional study examined anxiety sensitivity (and construct sub-facets) as a predictor of opioid misuse among adults with chronic pain. Method: Adults reporting chronic pain and prescription opioid use completed an online survey. Results: Anxiety sensitivity was associated with multiple aspects of opioid misuse, including current opioid misuse, severity of opioid dependence, and number of opioids used to get high. The magnitude of effects ranged from medium to large. Associations between anxiety sensitivity and opioid misuse were observed over and above the variance accounted for by age, sex, income, education, perceived health, and pain severity. Conclusion: These findings suggest that anxiety sensitivity may be an important treatment target among adults with chronic pain who misuse opioids. Future research should continue to explore the explanatory relevance of anxiety sensitivity in opioid misuse among individuals with chronic pain.

The development and initial validation of the Fatigue Sensitivity Questionnaire.

Currently, there is poor understanding of fatigue and the possible psychological conditions that may underlie chronic fatigue. Although substantial work has been directed to better clinically address fatigue, no work has explored individual differences in expectations or perceptions of the negative consequences associated with fatigue-related symptoms. The goals of this study were to (a) develop and (b) validate a measure of expectations or perceptions of the negative consequences associated with fatigue-related symptoms (e.g. fatigue sensitivity) across two independent samples (N = 1,827; 73.1% female; Mage = 21.68; SD = 4.54) of young adults. Results supported a 10-item measure of fatigue sensitivity, entitled the Fatigue Sensitivity Questionnaire (FSQ). The FSQ demonstrated unidimensionality, excellent internal consistency, and strong convergent and discriminant validity. Overall, the 10-item scale offers a single score that can be employed to measure fatigue sensitivity. Clinically, the FSQ may be a brief, informative, and easily disseminated measure in better understanding and capturing expectations or perceptions about the negative consequences of fatigue. As a research tool, the use of the FSQ may provide broader understanding of vulnerability factors that may influence fatigue-related health outcomes. Future research is needed to test the validity of the FSQ in other samples.

Insomnia and eating expectancies among college students: the role of emotion dysregulation.

There is limited understanding of the relation between insomnia and aspects of eating among college students though available data suggest salient clinical relationships. The present study explored a potential transdiagnostic mechanism in the relation between insomnia symptoms and eating expectancies. Participants were a racially/ethnically diverse sample of 1589 college students (80.4% females; Mage = 22.2 years, SD = 5.27) from an urban university. Primary analysis included three regression-based models of eating expectancies. Insomnia symptoms served as the predictor, and emotion dysregulation served as the indirect (mediator) variable in all models. Results indicated that insomnia symptoms yielded a significant indirect effect through emotion dysregulation on expectancies of eating to help manage negative affect, alleviate boredom, and lead to feeling out of control. Students experiencing insomnia symptoms may be at higher risk for experiencing dysregulated emotions and consequently maladaptive eating expectancies compared to good sleepers.

Body Mass Index and functional impairment: the explanatory role of anxiety sensitivity among treatment-seeking smokers.

Obesity and smoking are highly prevalent public health concerns in the United States. Data indicate that elevated Body Mass Index (BMI) is related to functional impairment. However, there is limited understanding of mechanisms that may explain their comorbidity among smokers. The current study sought to test whether anxiety sensitivity explained the relation between BMI and functional impairment among 420 (46.9% females; Mage = 38 years, SD = 13.42) treatment-seeking, adult smokers. Results indicated that BMI yielded a significant indirect effect through anxiety sensitivity for functional impairment, b = 0.01, SE = .01, 95% CI = [.002, .021]. These findings remained significant after controlling for participant sex, negative affectivity, tobacco dependence, psychopathology, and medical conditions (i.e. hypertension, heart problems, respiratory disease, asthma). Such data provide novel empirical evidence that, among smokers, BMI may be a risk factor for functional impairment indirectly through anxiety sensitivity. Overall, such findings could potentially inform the development of personalized interventions among this particularly vulnerable segment of the smoking population.

The Moderating Effect of Smoking Status on the Relation between Anxiety Sensitivity, Sexual Compulsivity, and Suicidality among People with HIV/AIDS.

PURPOSE: The present study examined the moderating effect of cigarette smoking status on the relation between anxiety sensitivity (fear of the expected negative consequences of anxiety and bodily sensations) and hazardous alcohol consumption, sexual compulsivity, and suicidality. METHOD: A series of multiple hierarchical regressions were used to test the proposed hypothesis among a sample of 94 persons living with HIV/AIDS in the USA (64.5 % male, M age = 48.3, SD = 7.5). Fifty-seven percent of the participants (n = 54) reported past-month smoking. RESULTS: The results indicated that those who reported smoking and had higher anxiety sensitivity demonstrated the highest rates of hazardous alcohol use, sexual compulsivity, and suicidality. Simple slope analyses indicated that anxiety sensitivity was associated with higher rates of hazardous alcohol use, sexual compulsivity, and suicidality among individuals who reported past-month smoking, but not among individuals who did not smoke. CONCLUSION: The present results suggest that smoking status moderates the relation between anxiety sensitivity and hazardous alcohol use, sexual compulsivity, and suicidality among persons living with HIV/AIDS. These data add to a growing literature, suggesting that smoking has a negative impact among persons living with HIV/AIDS, which extends beyond physical health problems to a variety of clinically significant behavioral health sequelae.