Posttraumatic Stress and Opioid Use and Pain among Individuals with Probable Posttraumatic Stress Disorder and Self-Reported Chronic Pain: The Role of Health Literacy.

BACKGROUND: Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting. OBJECTIVE: The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability. METHOD: The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication. RESULTS: Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability. CONCLUSION: The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain.

Posttraumatic Stress and Alcohol Use Among Hispanic/Latinx University Students: A Moderated Indirect Effect Model of Coping-Related Drinking and Anxiety Sensitivity.

OBJECTIVE: Posttraumatic stress symptoms (PTSS) and anxiety sensitivity (AS) are associated with increased alcohol use and coping-motivated drinking among university students. This study among trauma-exposed Hispanic/Latinx university students sought to examine the indirect effect of PTSS on alcohol use severity through coping-motivated drinking and test the moderating role of AS and AS subfacets. METHODS: University students who identified as Hispanic/Latinx (N = 830) were recruited from a large, urban, southern university and completed online, self-report questionnaires. RESULTS: A significant interactive effect of PTSS and AS on coping-motivated drinking emerged. PTSS exerted a significant indirect effect on alcohol use severity, through coping-motivated drinking. Simple slope analyses revealed that PTSS was associated with coping-motivated drinking across all levels of AS. Post hoc results revealed unique biological sex differences in probable diagnosis odds ratios. CONCLUSIONS: These findings indicate that PTSS and AS are associated with coping-motivated drinking and alcohol use severity in trauma-exposed, Hispanic/Latinx university students.

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.

PTSD Symptom Severity and Alcohol Use among Firefighters: The Role of Emotion Regulation Difficulties.

OBJECTIVE: Heightened rates of posttraumatic stress disorder (PTSD) symptoms and alcohol use have been documented among firefighters. Emotion regulation difficulties (ERD) are clinically relevant to both PTSD and alcohol use. Few studies have examined the role of ERD in the association of PTSD symptoms with alcohol use severity and alcohol use motives among firefighters. Thus, the present investigation examined the indirect effect of PTSD symptom severity on alcohol use severity and alcohol use motives through ERD. METHODS: The sample was comprised of 685 firefighters (Mage = 38.65, SD = 8.57, 93.6% male) recruited from an urban fire department in the southern U.S. to complete an online survey. Indirect effects were calculated using 10,000 bootstrapped samples. Effects were examined after accounting for years of fire service, occupational stress, trauma load (i.e., number of traumatic event types experienced); in models evaluating alcohol use motives as outcomes, other alcohol use motives (i.e., alternate motives subscales) were included as additional covariates. RESULTS: First, ERD explained the association of PTSD symptom severity with alcohol use coping motives (ß = .01, SE = .003, 95% CI [.004-.01]). Furthermore, ERD did not significantly account for the association of PTSD symptom severity with alcohol use severity (ß = .02, SE = .01, 95% CI [-.004-.04]), alcohol use enhancement motives (ß = -.003, SE = .002, 95%CI [-.007-.000]), alcohol use social motives (ß = .004, SE = .002, 95% CI [-.000-.01]), or alcohol use conformity motives (ß = -.002, SE = .002, 95% CI [-.006-.02]). CONCLUSIONS: Results demonstrated that, among firefighters, PTSD symptom severity is positively related to alcohol use coping motives through heightened ERD. Clinical implications and future directions are discussed.

Posttraumatic Stress, Alcohol Use, and Alcohol Use Motives among Non-Hispanic Black/African American College Students: The Role of Emotion Regulation.

OBJECTIVE: The associations between posttraumatic stress disorder (PTSD) symptom severity, alcohol use, and alcohol use motives are well-established. Emotion regulation difficulties have been implicated in the association between PTSD symptoms and alcohol use. A dearth of empirical work, however, has examined these associations among Black/African American college students, a population with high prevalence of exposure to potentially traumatic events, PTSD symptomatology, and alcohol-related consequences. METHODS: This study examined PTSD symptoms, emotion regulation difficulties, and alcohol use severity and motives among a sample of Black/African American trauma-exposed college students (N = 282; 77.4% identified as female; M age = 22.36, SD = 4.71). RESULTS: PTSD symptom severity was related to alcohol use and coping and conformity motives for alcohol use through heightened emotion regulation difficulties. Findings were significant above and beyond the effects of trauma load (i.e., number of potentially traumatic event types experienced). CONCLUSIONS: This study extends past work to an understudied population and contributes to groundwork for culturally informed interventions.

Associations of resilience and hope with mental and physical health among firefighters.

OBJECTIVE: Firefighters represent an understudied population with high rates of chronic exposure to stress and potentially traumatic events. Thus, there is a need to identify modifiable resilience factors to address posttraumatic stress disorder (PTSD) symptoms (PTSD) and chronic pain in firefighters to inform prevention and intervention efforts. METHODS: The current sample included 155 firefighters (93.5% male; Mage = 42.2, SD = 9.8) recruited online from career, volunteer, and combination (i.e., volunteer and career) departments in a large metropolitan area in the southern United States. RESULTS: Structural equation modeling (SEM) was used to investigate the associations between/among resilience and hope on PTSD symptoms, chronic pain, well-being, and posttraumatic growth (PTG). Resilience had a stronger, negative relationship with PTSD and chronic pain compared to hope, while hope had a stronger, positive relationship with PTG and well-being compared to resilience. Hope and resilience combined predicted 10%-33% of the variance in the outcomes. CONCLUSION: The current findings may provide evidence to promote interventions that increase resilience and hope in firefighters.

Distress tolerance: prospective associations with cognitive-behavioral therapy outcomes in adults with posttraumatic stress and substance use disorders.

74Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; Mage = 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e. proportion of number of use days to total number of days between two final treatment sessions).

The Role of Functional Health Literacy in terms of Harmful Alcohol Use in Adults with Probable Posttraumatic Stress Disorder and Alcohol Use Disorder.

Purpose: The current study examined functional health literacy (FHL) in regard to hazardous drinking among a sample with probable posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Methods: Participants were 565 adults with probable PTSD and hazardous alcohol use (52.2% female, 68.8% Non-Hispanic White, average age = 39.2 years ± 10.9 years). Results: FHL literacy maintained statistically significant role in terms of hazardous drinking (p < .001) even in the context of posttraumatic stress. Conclusion: FHL may be important to better understand hazardous drinking among persons with comorbid PTSD and AUD.

Associations between Sleep Disturbance and Suicidal Ideation Severity in Iranian University Students: Evaluating Emotion Regulation Difficulties and Distress Tolerance.

AIM: Although sleep disturbance is associated with suicide ideation, underlying cognitive-affective mechanisms that may explain this association are not well understood. The aim of the present study was to concurrently evaluate whether emotion regulation difficulties and distress tolerance explain this association among Iranian university students. METHOD: A total of 679 Iranian university students (66.42% females; Mage = 24.34 years, SD = 4.86) completed a battery of online self-report questionnaire. Structural equation modeling was used to empirically explore the relations among variables. RESULTS: Sleep disturbance was positively associated with suicide ideation. Higher sleep disturbance symptoms were associated with higher levels of suicide ideation. Sleep disturbance was indirectly related to suicide ideation through both emotion regulation difficulties and distress tolerance. CONCLUSION: Findings expand knowledge of cognitive-emotional processes that may explain the sleep disturbance-suicide ideation association among Iranian university students. Iranian students experiencing sleep disturbance may benefit from intervention strategies targeting emotion regulation skills and distress tolerance to reduce suicide ideation.

Posttraumatic stress and alcohol use among Hispanic/Latina survivors of interpersonal trauma: Associations with anxiety sensitivity and distress tolerance.

OBJECTIVE: Hispanic/Latina students experience elevated rates of binge drinking, interpersonal trauma, and posttraumatic stress disorder (PTSD) symptoms. Research has indicated anxiety sensitivity (AS; i.e., fear of anxiety-related bodily sensations) and distress tolerance (DT; i.e., ability to tolerate negative emotional states) are modifiable psychological mechanisms related to alcohol use and PTSD symptoms. However, a dearth of literature has focused on factors that may account for associations between alcohol use and PTSD among Hispanic/Latina students. METHOD: The project examined, among 288 Hispanic/Latina college students (Mage = 23.3 years, SD = 5.4) with interpersonal trauma histories, the indirect effects of PTSD symptom severity on (a) alcohol use and (b) alcohol use motives (i.e., coping, conformity, enhancement, social) via DT and AS, evaluated as parallel statistical mediators. RESULTS: Results PTSD symptom severity had an indirect effect on (a) alcohol use severity; (b) conformity motives for alcohol use; and (c) social motives for alcohol use via AS but not DT. PTSD symptom severity was associated with coping-oriented drinking via both AS and DT. CONCLUSIONS: This research has the potential to advance culturally-informed literature on factors that may impact co-occurring PTSD symptoms and alcohol use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The main and interactive effects of distress tolerance and reward function on posttraumatic stress disorder symptoms among firefighters.

BACKGROUND: Firefighters are at heightened risk of posttraumatic stress disorder (PTSD), underscoring the importance of understanding clinically targetable factors to inform evidence-based intervention development. Hedonic capacity, or the ability to experience pleasure, is a facet of reward functioning. Anhedonia (i.e., low or absent hedonic capacity) is a hallmark symptom of PTSD. Distress tolerance (DT), or the perceived ability to withstand negative emotional states, has also demonstrated associations with PTSD. OBJECTIVE: The purpose of the present study was to examine the main and interactive effects of self-reported hedonic capacity (Snaith-Hamilton Pleasure Scale) and DT (Distress Tolerance Scale) on PTSD symptom severity among firefighters. METHOD: A hierarchical linear regression was performed among a sample of 802 trauma-exposed career firefighters, who completed a battery of self-report questionnaires. Covariates included trauma load (i.e., number of trauma types), years in the fire service, and depression symptoms (excluding anhedonia). RESULTS: Both hedonic capacity (B = 2.71, SE = .95, p = .005) and DT (B = -.21, SE = .03, p < .001) were incrementally associated with PTSD symptom severity. The interactive effect of hedonic capacity and DT was associated with heightened PTSD symptom severity (B = .25, SE = .07, p < .001). CONCLUSIONS: Hedonic capacity and DT were independently and transactionally associated with heightened PTSD symptom severity among trauma-exposed firefighters. These findings provide evidence for the utility in developing interventions that target DT and impaired hedonic capacity among firefighters, particularly those experiencing PTSD symptomatology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity.

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; Mage = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.

Aggressive Worriers: How Aggression Moderates the Association between Intolerance of Uncertainty and Suicidal Desire Constructs.

Suicide is a public health concern and has been the tenth leading cause of death in the United States since 2008. The Interpersonal-Psychological Theory of Suicidal Behavior is an empirically supported model of suicide. The theory posits that thwarted belongingness and perceived burdensomeness examine the individual's perceived connectedness to others around them and together create suicidal desire. Anxiety is another widespread public health concern, associated with suicidal ideation and suicide attempts above and beyond the effects of socio-demographic factors and other mental disorders. A key factor in anxiety disorders is intolerance of uncertainty, or the individual's tendency to perceive ambiguous situations and events as being aversive to emotional and behavioral well-being. Additionally, different facets of aggression have been associated with both intolerance of uncertainty and suicidal desire. The current study sought to examine how facets of aggression moderated the associations between intolerance of uncertainty (both prospective and inhibitory) and thwarted belongingness/perceived burdensomeness. Participants were 440 adults recruited online. The hypotheses of aggression facets moderating the association between intolerance of uncertainty and perceived burdensomeness were largely supported with statistical significance for six out of eight models. Similarly, the hypotheses of aggression facets moderating thwarted belongingness were largely supported with significant moderations for seven out of eight models. The results were upheld when using Benjamini-Hochberg test of significance to account for Type I error. Overall, results indicate that aggressive facets can amplify the associations between intolerance of uncertainty and thwarted belongingness/perceived burdensomeness; however, results differed based on the intolerance of uncertainty dimensions.

Anxiety sensitivity and substance use: Differential levels across individuals primarily using opioids, cannabis, or stimulants.

BACKGROUND: The purpose of the current study was to compare levels of anxiety sensitivity (AS) across a treatment-seeking sample of individuals primarily using opioids, stimulants, or cannabis. Consistent with the idea that individuals high in AS may be motivated to use substances with real or perceived anxiolytic properties, it was hypothesized that individuals primarily using opioids or cannabis would evidence higher levels of AS compared to individuals primarily using stimulants. METHODS: The sample consisted of 110 veterans (including 29 individuals primarily using opioids, 42 primarily using cannabis, and 39 primarily using stimulants) presenting for psychological services to a Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) specialty clinic at a large southeastern Veteran Affairs (VA) hospital. RESULTS: AS levels varied by group with individuals primarily using stimulants evidencing the highest levels followed by those primarily using opioids and then those primarily using cannabis. Individuals primarily using stimulants had statistically significantly higher levels of AS physical concerns compared to individuals primarily using cannabis but not those primarily using opioids. Further, individuals who primarily use opioids did not differ from those primarily using cannabis. CONCLUSIONS: Taken together, these findings call into question the notion that AS may be negatively related to the use of substances that have anxiogenic properties.

Correlates of death among SARS-CoV-2 positive veterans: The contribution of lifetime tobacco use.

Despite a growing body of research examining correlates and consequences of COVID-19, few findings have been published among military veterans. This limitation is particularly concerning as preliminary data indicate that veterans may experience a higher rate of mortality compared to their civilian counterparts. One factor that may contribute to increased rates of death among veterans with COVID-19 is tobacco use. Indeed, findings from a recent meta-analysis highlight the association between lifetime smoking status and COVID-19 progression to more severe or critical conditions including death. Notably, prevalence rates of tobacco use are higher among veterans than civilians. Thus, the purpose of the current study was to examine demographic and medical variables that may contribute to likelihood of death among veterans testing positive for SARS-CoV-2. Additionally, we examined the unique influence of lifetime tobacco use on veteran mortality when added to the complete model. Retrospective chart reviews were conducted on 440 veterans (80.5% African American/Black) who tested positive for SARS-CoV-2 (7.3% deceased) at a large, southeastern Veterans Affairs (VA) hospital between March 11, 2020 and April 23, 2020, with data analysis occurring from May 26, 2020 to June 5, 2020. Older age, male gender, immunodeficiency, endocrine, and pulmonary diseases were positively related to the relative risk of death among SARS-CoV-2 positive veterans, with lifetime tobacco use predicting veteran mortality above and beyond these variables. Findings highlight the importance of assessing for lifetime tobacco use among SARS-CoV-2 positive patients and the relative importance of lifetime tobacco use as a risk factor for increased mortality.

An initial investigation of the association between distress intolerance and posttraumatic stress within military sexual trauma survivors.

OBJECTIVE: Researchers have recently found several links between distress intolerance (DI), the perceived inability to withstand aversive emotional and somatic states, and posttraumatic stress disorder (PTSD) symptoms. Despite this well-established relationship, DI has yet to be examined among victims of military sexual trauma (MST), a population known to have increased rates of PTSD. Thus, the purpose of the current study was to examine overall rates of DI, as well as the relationship between DI and PTSD symptom and cluster severity using an outpatient sample of MST survivors. METHOD: The sample included 103 veterans presenting for psychological services to an MST specialty clinic at a large southeastern Veterans Affairs hospital. As part of their intake evaluation, veterans completed a brief battery of self-report questionnaires to assist with diagnostic clarification and treatment planning. RESULTS: Results revealed that DI was significantly associated with PTSD symptom severity above and beyond depression symptoms. Further, DI was significantly associated with the PTSD intrusion, negative alterations in cognitions and mood, and arousal and reactivity clusters. DISCUSSION: These findings provide initial evidence for a relationship between DI and PTSD symptoms within MST patients. Pending further research, investigators should determine the extent to which targeting this cognitive-behavioral construct reduces PTSD symptoms among MST samples. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A computerized anxiety sensitivity intervention for opioid use disorders: A pilot investigation among veterans.

The opioid epidemic is having a disproportionate impact on veterans. Indeed, veterans are twice as likely to die from an accidental overdose than members of the general population, even after accounting for gender and age distribution. Although many veterans seek treatment, a large proportion drop out prematurely and/or relapse highlighting the need to identify malleable factors that may contribute to the recovery process. One such variable is anxiety sensitivity (AS; i.e., fear of anxious arousal). AS is elevated in opioid use populations and is a predictor of treatment dropout among opioid users. Importantly, research suggests that AS is highly malleable; although, no studies have systematically examined such protocols among opioid users. To this end, the purpose of the proposed study was to test the acceptability, feasibility, and utility of a brief, one-session Computerized Anxiety Sensitivity Treatment (termed CAST) delivered to veterans seeking services for an opioid use disorder (OUD). Veterans (n = 16) were assessed at baseline and also at one-week and one-month following CAST. All veterans completed the protocol and reported being interested and engaged during the intervention. Further, small to medium reductions in psychopathology and substance use outcomes were found. Although more work is needed, the current study provides preliminary support for the effectiveness of a brief AS-focused intervention among veterans seeking treatment for an OUD.