Risk estimation in relation to anxiety and depression for low probability negative events.

Foundational cognitive models propose that people with anxiety and depression show risk estimation bias, but most literature does not compute true risk estimation bias by comparing people's subjective risk estimates to their individualized reality (i.e., person-level objective risk). In a diverse community sample (N = 319), we calculated risk estimation bias by comparing people's subjective risk estimates for contracting COVID-19 to their individualized objective risk. Person-level objective risk was consistently low and did not differ across symptom levels, suggesting that for low probability negative events, people with greater symptoms show risk estimation bias that is driven by subjective risk estimates. Greater levels of anxiety, depression, and COVID-specific perseverative cognition separately predicted higher subjective risk estimates. In a model including COVID-specific perseverative cognition alongside anxiety and depression scores, the only significant predictor of subjective risk estimates was COVID-specific perseverative cognition, indicating that symptoms more closely tied to feared outcomes may more strongly influence risk estimation. Finally, subjective risk estimates predicted information-seeking behavior and eating when anxious, but did not significantly predict alcohol or marijuana use, drinking to cope, or information avoidance. Implications for clinical practitioners and future research are discussed.

Longitudinal predictors of post-exposure prophylaxis awareness among latino sexual minority men in South Florida.

Biomedical tools for HIV prevention such as post-exposure prophylaxis (PEP) continue to be underutilized by subgroups experiencing significant HIV inequities. Specifically, factors associated with both PEP awareness and uptake both cross-sectionally and longitudinally are under-researched, despite PEP being a part of the United States' Plan for Ending the HIV Epidemic. The current study examined longitudinal predictors of PEP awareness among Latino sexual minority men (LSMM) living in South Florida. This current study (N = 290) employed hierarchal linear modeling across three timepoints (baseline, 4-months, 8-months) to assess within-person and between-person effects over time for several psychosocial and structural factors. Most participants (67.5%) reported little to no awareness of PEP at baseline with general PEP awareness growing slightly across the study (60.5% reporting little to no awareness of PEP at 8 months). Results of the final conditional model suggest significant within-person effects of PrEP knowledge (p = 0.02) and PrEP self-efficacy (p < 0.001), as well as a significant positive between-person effect of PrEP knowledge (p < 0.01) on PEP awareness. Between-person HIV knowledge was also a significant predictor in this model (p = 0.01). This longitudinal analysis of LSMM's PEP awareness indicates that more must be done to increase PEP awareness among this subgroup. Future studies should explore how to build on existing interventions focused on HIV and PrEP knowledge and PrEP self-efficacy to incorporate information about PEP to increase the reach of this effective biomedical HIV prevention tool.

Urged to feel certain again: The role of emotion-related impulsivity on the relationships between intolerance of uncertainty and OCD symptom severity.

OBJECTIVES: Obsessive-compulsive disorder (OCD) is a debilitating mental disorder characterized by persistent and intrusive thoughts accompanied by repetitive mental or physical acts. While both intolerance of uncertainty and emotion-related impulsivity have been consistently evidenced as cognitive risk factors of OCD, no studies have considered their joint effects. The current study examined the interaction between intolerance of uncertainty and two forms of emotion-related impulsivity-including both a behavioural and cognitive form-in predicting OCD symptoms. DESIGN: Cross-sectional data were collected online from community-based adult participants. METHODS: Participants (N = 673) completed a battery of self-report measures of OCD symptom severity, intolerance of uncertainty, and emotion-related impulsivity. RESULTS: The behavioural form of emotion-related impulsivity positively moderated the relationship between intolerance of uncertainty and OCD symptoms. Elevated levels of both factors predicted the most severe symptoms, particularly checking, washing, and obsessing. This interaction effect was not found for the cognitive form of emotion-related impulsivity, which still emerged as a unique predictor of OCD symptom severity, specifically obsessing symptoms. CONCLUSIONS: Current findings furthered the understanding of the link between intolerance of uncertainty and OCD symptoms by highlighting the role of emotion-related impulsivity. When uncertainty triggers distress in individuals with high intolerance of uncertainty, the urge to behaviourally alleviate this distress could promote the use of maladaptive obsessions and compulsions, leading to greater OCD symptoms. Results also indicated the potentially differential effects from the behavioural versus cognitive forms of emotion-related impulsivity on different symptom domains, and the mechanistic link here is worthy of further investigation.

Trait and situation-specific intolerance of uncertainty predict affective symptoms during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic, a high-uncertainty situation, presents an ideal opportunity to examine how trait intolerance of uncertainty (IU) and situation-specific IU relate to each other and to mental health outcomes. The current longitudinal study examined the unique associations of trait and COVID-specific IU with general distress (anxiety and depression) and pandemic-specific concerns (pandemic stress and vaccine worry). METHODS: A community sample of Florida adults (N = 2152) was surveyed online at three timepoints. They completed measures of trait IU at Wave 1 (April-May 2020) and COVID-specific IU at Wave 2 (May-June 2020). At Wave 3 (December-February 2021), they reported symptoms of depression, anxiety, pandemic stress, and vaccine worry. RESULTS: We used structural equation modeling to test our overall model. Trait IU significantly predicted later COVID-specific IU, however there was no significant effect of trait IU on any outcome measure after accounting for COVID-specific IU. Notably, COVID-specific IU fully mediated the relationship between trait IU and all four symptom measures. LIMITATIONS: There were several limitations of the current study, including the use of a community sample and high participant attrition. CONCLUSIONS: Results suggest that COVID-specific IU predicts mental health outcomes over and above trait IU, extending the existing literature. These findings indicate that uncertainty may be more aversive when it is related to specific distressing situations, providing guidance for developing more specific and individualized interventions. Idiographic treatments which target situation-specific IU may be more efficacious in reducing affective symptoms and related stress during the COVID-19 pandemic or other similar events.

Does Emotion-Related Impulsivity Relate to Specific ADHD Symptom Dimensions, and Do the Effects Generalize Across Comorbid Internalizing and Externalizing Syndromes?

BACKGROUND: Recent work highlights the role of emotion dysregulation in the pathology of Attention-Deficit/Hyperactivity Disorder (ADHD). As such, emotion-related impulsivity (ERI), the trait-like tendency toward disinhibited thoughts (Pervasive Influence of Feelings, PIF) and actions (Feelings Trigger Action, FTA) during heightened emotional states, may be particularly relevant. We explored whether Inattention (IN) and Hyperactivity/Impulsivity (HI), two core symptom dimensions of ADHD, would relate to distinct facets of ERI, and whether externalizing and internalizing symptoms would moderate these relations. METHOD: Using structural equation modeling, we examined hypotheses among 364 adults recruited for high internalizing and externalizing symptoms. RESULTS: We identified significant paths for FTA regressed on HI and PIF regressed on IN, supporting our hypotheses about main effects. Moderating paths were not significant. CONCLUSIONS: IN and HI correlate with distinct forms of ERI, These effects appear to generalize across co-occurring internalizing and externalizing symptoms. Theoretical and clinical implications are discussed.

The impact of anxiety and intolerance of uncertainty on climate change distress, policy support, and pro-environmental behaviour.

OBJECTIVES: As the threat of climate change continues to grow, bolstering individual-level support for climate change initiatives is crucial. More research is needed to better understand how individual difference factors, such as climate change anxiety and intolerance of uncertainty (IU), may shape how people perceive climate change and respond to climate change messaging. To date, the majority of published studies have not taken these individual difference factors into consideration, and IU has been particularly neglected in the climate change literature. This study examined the independent effects of climate change anxiety and IU on three climate change-related outcomes: climate-related distress, support for climate change policies, and behavioural engagement. METHODS: Participants were Florida residents (N = 441) who completed an online survey, including measures of climate change anxiety and IU. Participants then watched a video describing climate change consequences and completed three outcome measures: post-video distress, climate change policy support, and behavioural engagement. RESULTS: Controlling for demographic covariates, both climate change anxiety (ß = .43, p < .001) and IU (ß = .27, p < .001) were associated with greater post-video distress, but only IU independently predicted greater policy support (ß = .10, p = .034) and behavioural engagement (ß = .12, p = .017). CONCLUSIONS: Our findings suggest that IU may be an important factor in promoting pro-environmental behaviour and policy support, but climate change anxiety may increase emotional distress without boosting meaningful behaviours or support. Our findings highlight the potential influence of cognitive factors on climate change engagement and suggest that invoking uncertainty rather than anxiety may be more effective in catalysing effective environmental engagement.

On the impulsivity path: Examining the unique and conjoint relations between emotion- and non-emotion-related impulsivity, internalizing symptoms, alcohol use, and physical health parameters.

BACKGROUND: Researchers have increasingly differentiated trait-like tendencies toward impulsivity occurring during emotional states (emotion-related impulsivity [ERI]) from impulsivity not tied to emotion (non-ERI). Relative to non-ERI, ERI has shown robust correlations with psychopathology and mild to moderate associations with physical health parameters (e.g., physical activity, poor sleep quality, body mass index [BMI]). Therefore, we first aimed to investigate the unique contributions of ERI and non-ERI to psychopathology symptoms while controlling for neuroticism. Second, we sought to explore the combined associations of physical health parameters with several impulsivity forms. METHODS: German-speaking adults (N = 350, 35.9 ± 14.6 years, 69.1% female, BMI: 24.0 ± 4.8 kg/m2 , mostly students or employees) completed measures of impulsivity, psychopathology symptoms, neuroticism, and physical health. We gathered measures of two ERI forms: Feelings Trigger Action and Pervasive Influence of Feelings. As a control comparison, we gathered a measure of non-ERI, the Lack of Follow-Through scale. We conducted separate path models for Aims 1 and 2. RESULTS: For Aim 1, Pervasive Influence of Feelings showed strong links with internalizing symptoms. Feelings Trigger Action and Lack of Follow-Through showed small links with alcohol use. For Aim 2, poor sleep quality was related to all three impulsivity factors, while physical activity was only related to Pervasive Influence of Feelings and Lack of Follow-Through. BMI showed a curvilinear association with impulsivity. CONCLUSIONS: ERI is more directly relevant than non-ERI for psychopathology symptoms, emphasizing the need to differentiate between the two ERI types. The association of ERI and non-ERI with physical activity and poor sleep quality may serve as potential treatment targets for impulsivity-related problems.

Psychosocial and health stressors during the COVID-19 pandemic and their association with sleep quality.

OBJECTIVE: We investigated how psychosocial and health stressors and related cognitive-affective factors were differentially associated with sleep quality during the early months of the COVID-19 pandemic. METHODS AND MEASURES: Adults living in Florida (n = 2,152) completed a Qualtrics survey in April-May 2020 (Wave 1). Participants (n = 831) were reassessed one month later (Wave 2; May-June 2020). At Wave 1, participants reported their level of physical contact with someone they care about, presence of a pre-existing chronic disease, employment status, loneliness, health worry, and financial distress. At Wave 2, participants rated their quality of sleep and insomnia symptoms. RESULTS: Loneliness, but not health worry or financial distress, directly predicted worse sleep quality. Lack of physical contact was indirectly associated with worse sleep quality via greater levels of loneliness. Further, results showed the presence of a pre-existing chronic disease was associated with both greater health worry and worse sleep quality. CONCLUSION: Loneliness was the sole cognitive-affective predictor of worse sleep quality when controlling for other psychosocial factors. As expected, adults living with a chronic disease reported impaired sleep quality. Understanding the processes influencing sleep quality during a significant time of stress is important for identifying risk factors, informing treatment, and improving sleep health beyond the pandemic.

Situational uncertainty interacts with anxiety sensitivity and distress intolerance to predict anticipated worry and preparation for a hurricane.

BACKGROUND: There is evidence for the impact of emotional intolerance on reactivity to stressors, but it is unknown whether the level of situational uncertainty may moderate this relationship. We examined whether situational uncertainty moderated the relationship between emotional intolerance and anticipated anxious responding to hurricane forecasts, considering three aspects of emotional tolerance: anxiety sensitivity, distress intolerance, and hurricane-specific distress intolerance. METHODS: Participants (N = 358) were Florida residents who experienced Hurricane Irma. Participants were presented with two hypothetical storm forecasts that varied in level of uncertainty: 5-day forecast (high uncertainty) and 3-day forecast (low uncertainty). Participants rated their anticipated worry and preparation for each forecast. RESULTS: Significant interactions between forecast uncertainty and both anxiety sensitivity and hurricane-specific distress intolerance emerged on anticipated worry, such that there was a stronger relationship in the high uncertainty condition. Forecast uncertainty also moderated the relationship between anxiety sensitivity and anticipated preparation in the same direction. There were no significant interactions between forecast uncertainty and distress intolerance on either anticipated worry or preparation. CONCLUSIONS: Specific aspects of emotional intolerance appear to have a stronger influence on anticipated worry and preparatory behavior in high uncertainty situations. These findings suggest that distinct emotional tolerance factors may influence these responses.

The relationship between health worry, work distress, and affective symptoms during the COVID-19 pandemic: The mediating role of hopelessness and helplessness.

OBJECTIVES: The COVID-19 pandemic presented both serious health threats and economic hardships, which were reflected in increased rates of mood and anxiety symptoms. We examined two separate distress domains, health worries and work distress, as predictors of mood and anxiety symptoms. Additionally, we considered whether these two domains might be uniquely associated with the development of dysfunctional beliefs, as a proposed mechanism to account for increased symptoms during the pandemic. Two separate models were considered to examine if associations remained stable through the first year of the pandemic. METHODS: Participants (N = 2152) were a representative sample of Florida adults. They completed online surveys at three waves: Wave 1 (April-May 2020), Wave 2 (May-June 2020), and Wave 3 (December-February 2021). Participants completed measures of COVID-19 health worry and work distress, anxiety, and depression. They also reported their level of hopelessness and helplessness (indices of dysfunctional beliefs). RESULTS: In an early pandemic model (Wave 1-Wave 2), health worry directly and indirectly predicted anxiety and depression via dysfunctional beliefs. In contrast, work distress only indirectly predicted both outcomes. In a longer-term model (Wave 2-Wave 3), health worry had direct and indirect effects on downstream anxiety but not depression. Pandemic work distress had no effect on depression or dysfunctional beliefs; however, it was associated with less anxiety. CONCLUSIONS: Although health worry and work distress predicted later symptoms of anxiety and depression, they appeared to operate through different pathways. These findings provide guidance for the development of more effective interventions to reduce the impact of pandemics.

A longitudinal investigation of COVID-19 pandemic experiences and mental health among university students.

OBJECTIVES: Previous studies have established a link between the COVID-19 pandemic and poor mental health. They further suggest that young adults may be especially vulnerable to worsened mental health during the pandemic, but few studies have investigated which specific aspects of the COVID-19 experience affect psychological well-being over time. To better understand concrete predictors of poor mental health outcomes in this population, we identified several pandemic-related experiences and evaluated their effects on mental health symptoms (depression, anxiety, stress, alcohol, and substance use) in a sample of U.S. college students (N = 176). METHODS: Both mental health symptoms and pandemic-related experiences were evaluated at the start of quarantine (March/April 2020, Time 1) and the end of the Spring 2020 semester (May 2020, Time 2). Given the limited literature on specific predictors of mental health during a pandemic, we used elastic net regression, a novel analytic method that helps with variable selection when theoretical background is limited, to narrow our field of possible predictors. RESULTS: While mental health symptoms were elevated at both timepoints, there were no clinically significant changes from Time 1 to Time 2 and few differences between sociodemographic groups. Both disruption due to the pandemic (ß = .25, p = .021) and limited confidence in the federal government's response (ß = -.14, p = .038) were significant predictors of depression symptoms at the end of the semester, even when controlling for baseline depression. Further, predictions that the pandemic would continue to impact daily life further into the future were linked with pandemic stress response symptoms (ß = .15, p = .032) at Time 2, beyond the effects of baseline symptoms. Alcohol (ß = -.22, p = .024) and substance use (ß = -.26, p = .01) were associated with reduced adherence to COVID-19 guidelines. CONCLUSIONS: Our findings indicate that specific aspects of the pandemic experience may be influencing internalizing symptoms and alcohol/substance use in college students, pointing to potential avenues for targeted support and intervention. PRACTITIONER POINTS: A range of factors may influence university student mental health during the COVID-19 pandemic. Students who expect the pandemic will continue to impact daily life further into the future maybe more likely to report stress symptoms. Disruption due to the pandemic and limited confidence in the federal government's response may be associated with depression symptoms. Alcohol and substance use are associated with lower COVID-19 guideline adherence in university students.

Alcohol substitution during one month of cannabis abstinence among non-treatment seeking youth.

OBJECTIVE: Cannabis and alcohol use are correlated behaviors among youth. It is not known whether discontinuation of cannabis use is associated with changes in alcohol use. This study assessed alcohol use in youth before, during, and after 4 weeks of paid cannabis abstinence. METHODS: Healthy, non-treatment seeking, cannabis users (n = 160), aged 14-25 years, 84% of whom used alcohol in the last month, were enrolled for a 4-week study with a 2-4 week follow-up. Participants were randomly assigned to 4 weeks of either biochemically-verified cannabis abstinence achieved through a contingency management framework (CB-Abst) or monitoring with no abstinence requirement (CB-Mon). Participants were assessed at baseline and approximately 4, 6, 10, 17, 24, and 31 days after enrollment. A follow-up visit with no cannabis abstinence requirement for CB-Abst was conducted after 2-4 weeks. RESULTS: Sixty percent of individuals assigned to the CB-Abst condition increased in frequency and quantity of alcohol consumption during the 4-week period of incentivized cannabis abstinence. As a whole, CB-Abst increased by a mean of 0.6 drinking days and 0.2 drinks per day in the initial week of abstinence (p's < 0.006). There was no evidence for further increases in drinking frequency or quantity during the 30-day abstinence period (p's > 0.53). There was no change in drinking frequency or quantity during the 4-week monitoring or follow-up periods among CB-Mon. CONCLUSIONS: On average, 4 weeks of incentivized (i.e., paid) cannabis abstinence among non-treatment seeking youth was associated with increased frequency and amount of alcohol use in week 1 that was sustained over 4 weeks and resolved with resumption of cannabis use. However, there was notable variability in individual-level response, with 60% increasing in alcohol use and 23% actually decreasing in alcohol use during cannabis abstinence. Findings suggest that increased alcohol use during cannabis abstinence among youth merits further study to determine whether this behavior occurs among treatment seeking youth and its clinical significance.

White matter integrity differences associated with post-traumatic stress disorder are not normalized by concurrent marijuana use.

Marijuana (MJ) use and post-traumatic stress disorder (PTSD) have both been associated with abnormalities in brain white matter tracts, including the cingulum and the anterior thalamic radiations (ATR), which project from subcortical regions to frontal cortex. Studies have not assessed the integrity of these tracts in patients with comorbid PTSD and MJ use. To examine effects of PTSD and MJ use on brain structure, we performed diffusion tensor imaging scans on seventy-two trauma-exposed participants, categorized into four groups: those with PTSD who used MJ at least weekly (PTSD+MJ; n = 20), those with PTSD with no regular MJ use (PTSD; n = 19), trauma-exposed controls without PTSD who used MJ (TEC+MJ; n = 14) and trauma-exposed controls with no PTSD or MJ use (TEC; n = 19). White matter integrity was evaluated by calculating fractional anisotropy (FA). Results showed that while FA values in the right ATR and the cingulum differed across groups, there were no significant interactions between PTSD and MJ in any white matter tracts, indicating that MJ exposure neither normalizes nor worsens white matter abnormalities in those with PTSD. Further study is needed to evaluate the impact of MJ use on other neurobiological markers of PTSD.