Symptom Discrimination and Habituation: A Case Study of Behavioral Treatment for Postural Orthostatic Tachycardia Syndrome (POTS).

Postural orthostatic tachycardia syndrome (POTS) is a multifaceted disorder of the autonomic nervous system that profoundly impacts physical functioning. In addition to physical consequences, many patients develop situational anxiety that causes reduced activity level, which may impede functional recovery from POTS. Despite links with anxiety, to date there have been no reports of psychological intervention for POTS. Here we report a case study of POTS in a 40-year-old female serving on active duty in the US military. Because there are no established guidelines for the psychological treatment of POTS, intervention techniques were adapted for use with the patient. Elements of cognitive behavioral therapy, including in-vivo exposure and symptom discrimination, were used to target avoidance of feared situations. Over the course of treatment, the patient learned to discriminate her POTS symptoms from anxiety and displayed a significant decrease in POTS-related functional impairment. Implications for future care are discussed.

Effects of depressed mood on drinking refusal self-efficacy: examining the specificity of drinking contexts.

College students with elevated depressive symptoms are more likely to engage in risky drinking and experience alcohol-related negative consequences. Efforts to understand the association between depressed mood and alcohol use have begun to identify the role of cognitive-motivational processes. Drinking refusal self-efficacy is one such process that influences the decision to drink, but its relationship with depressed mood remains unclear. The current study sought to clarify the role of these processes using a depressed mood induction procedure in a sample of college student drinkers. Eighty-six students were randomized to a depressed or neutral mood induction and completed assessments of drinking refusal self-efficacy. Depressed mood significantly decreased self-efficacy in high-risk drinking contexts related to depression, whereas ratings of other high-risk contexts were unaffected. These findings suggest that the association between hazardous drinking and depressed mood may be due in part to the direct influence of mood state on one's self-efficacy to resist drinking in relevant contexts.

The influence of depressed mood on action tendencies toward alcohol: the moderational role of drinking motives.

BACKGROUND: Research suggests that depressed mood is associated with alcohol-related problems, though its relation with drinking behavior has been inconsistent across studies. Efforts to better understand the link between depressed mood and alcohol use have examined drinking motives as a potentially important moderating variable. The current study sought to examine whether drinking motives moderate the influence of depressed mood on alcohol-related action tendencies. Based on Baker, Morse, and Sherman's (1986) positive and negative reinforcement schema model, two competing moderational hypotheses regarding the influence of depressed mood on appetitive responses for alcohol were tested. METHODS: One hundred and sixty-nine college student drinkers completed assessments of drinking motives and alcohol use. Subjects were exposed to a neutral or depressed mood induction followed by a computerized measure of action tendencies toward alcohol stimuli. RESULTS: Hierarchical regression analyses were conducted to examine whether the influence of depressed mood on action tendencies toward alcohol was moderated by drinking motives. Results showed that there was a significant interaction between mood induction condition and enhancement motives, such that depressed mood appeared to suppress appetitive responding toward alcohol among those with higher enhancement motives. In contrast, there was no evidence that coping motives moderated the association between mood and appetitive response to alcohol. CONCLUSIONS: These results suggest that inhibiting affect states associated with one's motivational disposition for drinking may result in the devaluation of alcohol. Limitations and implications are discussed.

Depressive symptoms and the implicit evaluation of alcohol: the moderating role of coping motives.

BACKGROUND: Depressive symptoms in college students have been associated with a number of indices of hazardous drinking. Investigators have utilized a variety of experimental paradigms to better understand the cognitive-motivational mechanisms that may underlie this association. Implicit cognition studies have provided increasing support for the view that coping motives may moderate the association between negative affect and the incentive value of alcohol. However, less is known about how symptoms of depression may be linked with implicit evaluative responses to alcohol. The current research sought to investigate the association between depressive symptoms and implicit evaluations of alcohol stimuli as measured by an evaluative priming task. METHODS: Eighty-two current drinkers completed assessments of depressive symptoms, alcohol use, and drinking motives before engaging in a computerized alcohol evaluative priming task. RESULTS: Analyses showed that the association between depressive symptoms and the positive implicit evaluation of alcohol was moderated by drinking motives, such that the positive association between depression and alcohol evaluation was stronger for students who had higher coping motives. CONCLUSIONS: These findings add to our understanding of how depressive symptoms may influence responses to alcohol and provide further support for the view that individual differences in coping motives may be a critical moderator of the association between depressive symptoms and alcohol-related cognitive motivational processes.

Life goals and alcohol use among first-year college students: the role of motives to limit drinking.

The main objective of the present study was to advance our understanding of how life goals are associated with hazardous alcohol use among first-year university students. One-hundred and seventeen students rated a series of self-generated life goals on meaning and efficacy and then completed alcohol assessments. Higher goal meaning ratings were associated with less alcohol use and fewer heavy drinking episodes. Tests of indirect effects showed that the associations between goal meaning ratings and alcohol use indices were mediated by motives to limit drinking, particularly the motive to maintain self-control/standards. These results replicate and extend previous work on goal meaning and hazardous drinking among students. Findings are consistent with the view that engagement in university life goals may serve as a protective factor against hazardous drinking among first-year students due to greater concern with the impact of drinking on their ability to attain goal standards.