Beliefs about mental health treatment, treatment initiation, and suicidal behaviors among veterans and service members at-risk for suicide and not in treatment.

INTRODUCTION: Previous research has identified a variety of barriers to mental health care among military personnel and veterans, despite high rates of mental health symptoms. The current study is the first to examine beliefs about mental health treatment barriers among post-9/11 military personnel and veterans at elevated suicide risk not involved in treatment and whether these beliefs are associated with treatment initiation, engagement, or suicidal behaviors. METHODS: Four hundred and twenty-two participants reported on beliefs about treatment during a cognitive behavioral treatment session and responded to follow-up questionnaires on mental health treatment initiation, engagement, and suicidal behaviors over 12 months. Beliefs identified in the therapy session were coded thematically, and rates of treatment initiation, engagement, and suicidal behavior were examined by belief category. RESULTS: Nine belief themes emerged. Participants reporting logistical barriers and preferences about treatment type were least likely to initiate mental health treatment and participated in the fewest number of sessions, respectively. Participants endorsing beliefs about stigma or using other ways to cope were most likely to engage in suicidal behavior. CONCLUSIONS: The current findings point to specific beliefs that may identify individuals who would benefit from systemic and individual interventions for mental health treatment engagement.

Conflicting patterns of cardiovascular reactivity, self-report, and behavior associated with social anxiety during a conversation with a close friend.

Social anxiety (SA) is characterized by anxious symptomology and fear during social situations, but recent work suggests that SA may not necessarily be associated with negative interpersonal and intrapersonal outcomes in support contexts. The current research investigates the discrepancies between self-perceptions, behavior, and physiological responses associated with SA in social support conversations with close friends. Specifically, we examined the associations between SA and positive and negative affect, perceptions of demands and resources, and responsiveness. Additionally, we used the biopsychosocial model of challenge and threat to understand the physiological responses associated with SA. Participants (79.9% White, 9.8% Black or African American, 10.3% Multiple races or other; 78.7% Female), totaling 172 undergraduate friend dyads, completed self-report measures and had physiological responses recorded while they discussed a problem unrelated to the friendship. Trained coders rated responsive behaviors exhibited during the conversation. Results revealed that greater SA was associated with greater negative perceptions of social interactions (greater negative affect, fewer perceived resources, and greater perceived demands). However, cardiovascular reactivity and behavioral responses within the conversation, as well as perceptions of partners' behavior after the conversation, contrasted with these negative perceptions. Indeed, greater SA was associated with greater sympathetic arousal (indicative of greater task engagement), but not with greater challenge or threat, and SA was not associated with perceived partner responsiveness or responsive behaviors. These results add to the growing body of research that suggests people with greater SA show inconsistencies between their conscious appraisals of social situations and their physiological responses.

A One-Arm Pilot Trial of a Telehealth CBT-Based Group Intervention Targeting Transdiagnostic Risk for Emotional Distress.

The COVID-19 pandemic had a significant impact on mental health, straining an already overburdened healthcare system. A modular, transdiagnostic approach to treating psychopathology may be ideal to target common transdiagnostic risk factors for emotional distress and related disorders likely to be impacted by circumstances related to this once-in-a-lifetime environmental stressor. Anxiety sensitivity (AS), or fear of anxious arousal, intolerance of uncertainty (IU), or distress when confronted with uncertainty, and loneliness are three transdiagnostic risk factors impacted by the pandemic and robust predictors of emotional distress beyond that. We completed a pilot feasibility, acceptability, and utility trial of Coping Crew, our group, telehealth-delivered transdiagnostic treatment protocol in 17 participants who completed the intervention (M age = 22.00, SD = 4.46; 71% female). The intervention and study protocol were feasible to deliver and were rated as acceptable and useful to address intervention targets. Evidence was mixed regarding feasibility, acceptability, and usefulness of the mobile app component. Sixteen of 17 participants (94%) completed at least one survey a day on 80% of the days but only 6 participants (35%) completed at least 80% of the mobile app surveys delivered over the course of the intervention. Most participants rated use of the app as acceptable and relevant to psychological improvements made due to the intervention. Sizeable effect size reductions in transdiagnostic risk factors were found at post-intervention and maintained at 1- and 3-month follow-up, supporting next steps in the development of this modular transdiagnostic treatment.

A randomized clinical trial to assess feasibility, acceptability and preliminary effects of telehealth-delivered cognitive-behavioral therapy for perceived social isolation among individuals with opioid use disorders.

BACKGROUND: The purpose of this study was to report on feasibility, acceptability, and initial efficacy data cognitive-behavioral therapy for perceived isolation (CBT-PSI) compared to health education among individuals with opioid use disorders (OUD) reporting elevated loneliness. METHODS: Participants (n = 125) with OUD reporting elevated loneliness were recruited using online advertising to participate in a telehealth-delivered randomized clinical trial. Participants received either a 6-session CBT-PSI (n = 63) or health education (n = 62). Measures assessing loneliness, quantity of social interactions, perceived social support, substance use, substance use consequences, and treatment engagement among others, were completed at baseline, post-intervention, and 1- and 2-months post-intervention. Participants also reported on treatment acceptability for both conditions. RESULTS: Target enrollment was met with loneliness, social disconnectedness measures, and substance use reflecting a clinically severe sample. Retention was high (> 80%) for both conditions. Participants rated both Health Education and CBT-PSI as acceptable, helpful, and useful interventions to address loneliness and opioid use. Loneliness was reduced and quantity of social interactions and perceived social support were increased to the same extent for both conditions and across the follow-up assessments. Opioid use and overall substance use were reduced in both conditions; however, the reductions among participants received CBT-PSI were significantly greater compared to Health Education. CONCLUSIONS: This study supports the feasibility and acceptability of CBT-PSI. CBT-PSI findings related to loneliness, substance use, and other social connectedness outcomes are encouraging. Additional testing of CBT-PSI in a fully-powered trial is warranted.

A Bifactor Evaluation of Self-Report and Clinician-Administered Measures of PTSD in Veterans.

The PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) are two of the most widely used and well-validated PTSD measures providing total and subscale scores that correspond with DSM-5 PTSD symptoms. However, there is little information about the utility of subscale scores above and beyond the total score for either measure. The current study compared the proposed DSM-5 four-factor model to a bifactor model across both measures using a sample of veterans (N = 1,240) presenting to a Veterans Affairs (VA) PTSD specialty clinic. The correlated factors and bifactor models for both measures evidenced marginal-to-acceptable fit and were retained for further evaluation. Bifactor specific indices suggested that both measures exhibited a strong general factor but weak lower-order factors. Structural regressions revealed that most of the lower-order factors provided little utility in predicting relevant outcomes. Although additional research is needed to make definitive statements about the utility of PCL-5 and CAPS-5 subscales, study findings point to numerous weaknesses. As such, caution should be exercised when using or interpreting subscale scores in future research.

Social concerns about anxious arousal explain the association between neural responses to anxious arousal pictures and social anxiety.

Cognitive theories propose that social anxiety disorder involves heightened attention to anxious arousal symptoms due to worries that they may evoke rejection from others. Supporting this, studies have shown that social anxiety is related to greater attention to representations of anxious arousal and to anxiety sensitivity social concerns, which refers to sensitivity to feelings of anxious arousal during social situations. However, this has not yet been tested using neural indices of attention to images depicting anxious arousal. To examine these associations, the current study examined early and sustained attentional bias to anxious arousal images using the P2 and the late positive potential (LPP), respectively. Electroencephalogram data were collected while a non-clinical sample of undergraduate students (N = 106) viewed images of people exhibiting anxious arousal in addition to blocks of negative and neutral images from the IAPS. The neural response to anxious arousal images was isolated using residual scores (e.g., using linear regression to predict the P2 elicited by anxious arousal images from the P2 elicited by neutral images (P2neutral→AA) or negative images (P2negative→AA), then saving the unstandardized residuals). There was an indirect effect of the P2neutral→AA and P2negative→AA waveforms that was explained by anxiety sensitivity social concerns. Additionally, there was an indirect effect of both LPP waveforms on social anxiety symptoms during the early time window of the LPP (400-700 ms). At the later time window of the LPP (700-1000 ms), there was an indirect effect of the LPPneutral→AA residual waveform, but not the LPPnegative→AA, on social anxiety symptoms.

Brief observable anxiety sensitivity treatment: intervention development and a pilot randomized-controlled acceptability and feasibility trial to evaluate a brief intervention for anxiety sensitivity social concerns.

Social anxiety disorder is one of the most prevalent anxiety disorders. There is a need to develop brief, virtual, single-session interventions targeting constructs associated with social anxiety, such as anxiety sensitivity social concerns (ASSC). ASSC is the maladaptive belief about consequences arising from observable symptoms of anxious arousal. This study was designed to evaluate the initial acceptability and feasibility of a brief ASSC reduction program (Brief Observable Anxiety Sensitivity Treatment [BOAST]) which included a single clinician-led intervention session followed by a two-week ecological momentary intervention (EMI), delivered via mobile app. Participants (N = 36) were adults with elevated ASSC who were randomly assigned to receive BOAST (n = 19) or a waitlist control (n = 17). The trial was prospectively registered at clinicaltrials.gov (NCT04859790). Results supported the acceptability of BOAST with mixed findings for feasibility. Feasibility metrics for the EMI component were below pre-defined thresholds; however, there was evidence that homework completion was associated with symptom reduction. Preliminary efficacy metrics indicated that participants in the BOAST condition had large reductions in ASSC and one measure of social anxiety at 1-month follow-up. This study provides preliminary support for the acceptability of BOAST and elucidates avenues for future clinical and research efforts.

Exploring trajectories in transdiagnostic behavior therapy.

Transdiagnostic treatments have been designed to target common processes for clusters of disorders. One such treatment, transdiagnostic behavior therapy (TBT), targets avoidance across emotional disorders, including posttraumatic stress disorder (PTSD), depressive disorders, and anxiety disorders, and has demonstrated efficacy in randomized controlled trials. The current study was designed to examine whether distinct treatment trajectories would emerge in a sample of 112 veterans receiving TBT and whether diagnostic comorbidity, baseline levels of several transdiagnostic risk factors, or treatment engagement influence trajectory membership. Growth mixture modeling revealed three distinct trajectories across depression, ds = 0.55-1.09; PTSD ds = -0.07-1.43; and panic disorder symptoms, ds = -0.13-1.09. Notably, for PTSD and panic disorder symptoms, separate classes for responders and nonresponders emerged among participants with high baseline symptom levels. Findings for the risk factors suggested that PTSD and panic nonresponders evidenced significantly higher behavioral avoidance at baseline and reduced engagement in treatment procedures and homework completion compared to responders. Together, the findings provide additional support for the use of TBT in the treatment of emotional disorders, including PTSD. Potential adaptations are discussed for patients with significantly elevated behavioral avoidance to improve treatment engagement and related outcomes.

A replication and extension of bifactor modelling of perseverative thought in an at-risk community sample: Exploring sex differences in the structure of PT.

BACKGROUND: Perseverative thought (PT) is a transdiagnostic construct associated with internalizing disorders. Bifactor models have shown that PT can be split into a general PT factor and lower-order factors for specific forms of PT, such as rumination and worry. No bifactor study to date has investigated if the structure of PT differs across sexes. METHODS: The study consisted of 280 individuals recruited for a larger study targeting risk factors for suicidal ideation and behaviours. Participants completed a diagnostic interview and self-report questionnaires. RESULTS: A two-factor model of PT fit best in males, whereas a bifactor model fit best in females. In a structural equation model, worry was associated with generalized anxiety disorder diagnoses in females, but not males. Rumination was associated with depressive disorder diagnoses in females, but not males. CONCLUSIONS: The present study contributes to a growing literature on PT; we found that dimensionality of PT varied by sex. We also found that relations between PT factors and generalized anxiety disorder differed by sex. Sex differences in the internalizing spectrum and related risk factors need to be considered when examining the structure and function of risk factors.

Anxiety sensitivity and social support in veterans with emotional disorders.

OBJECTIVE: An understanding of the incremental value of social support in predicting psychopathology above transdiagnostic risk factors could speak to the benefit of leveraging social factors into existing, evidence-based interventions in veterans with emotional disorders. This cross-sectional study aimed to expand our understanding of associations between domains of anxiety sensitivity and facets of psychopathology in veterans with emotional disorders. We also determined whether social support predicted psychopathology above anxiety sensitivity domains and combat exposure and explored these relationships with a path model. METHODS: One hundred and fifty-six treatment-seeking veterans with emotional disorders completed diagnostic interviews and assessments of demographics, social support, symptom measures (e.g., PTSD, depression, anxiety, and stress), and transdiagnostic risk factors (i.e., anxiety sensitivity). After data screening, 150 were included in regressions. RESULTS: Using regression analyses with cross-sectional data, cognitive anxiety sensitivity concerns predicted PTSD and depression above combat exposure. Cognitive and physical concerns predicted anxiety, and cognitive and social concerns predicted stress. Above combat exposure and anxiety sensitivity, social support predicted PTSD and depression. CONCLUSION: Focusing on social support in tandem with transdiagnostic mechanisms in clinical samples is critical. These findings inform transdiagnostic interventions and recommendations related to incorporation of assessment of transdiagnostic factors in clinical contexts.

Efficacy of CBT for Treatment Seeking (CBT-TS) in Untreated Veterans and Service Members at Risk for Suicidal Behavior.

OBJECTIVE: Military members and Veterans at-risk for suicide are often unlikely to seek behavioral health treatment. The primary aim of this study was to test the efficacy of brief CBT for Treatment Seeking (CBT-TS) to improve behavioral health treatment utilization among U.S. military service members and Veterans at-risk for suicide. METHODS: A total of 841 participants who served in the U.S. military since 9/11 and who reported suicidality but were not in behavioral health treatment were recruited to participate in this trial. Participants were randomly assigned to either brief CBT-TS delivered by phone or an assessment-only control condition. Follow-up assessments were conducted at baseline and months 1, 3, 6, and 12 to track treatment utilization and symptoms. RESULTS: CBT-TS resulted in significantly greater behavioral health treatment initiation within 1 month compared to the control condition (B = .93, p < .001); and the higher treatment initiation persisted for 12 months post intervention. CONCLUSIONS: This study employed a low-cost, easily implementable one-session intervention administered by phone. The study provides evidence that CBT-TS is efficacious in promoting behavioral health treatment initiation in an adult population at risk for suicidal behavior and showed enduring benefits for 6-12 months. CBT-TS provides a unique strategy for treatment engagement for at-risk adults unlikely to seek treatment. TRIAL REGISTRATION: Clinicaltrials.gov NCT05077514.

Anxiety Sensitivity and Intolerance of Uncertainty: Transdiagnostic Risk Factors for Anxiety as Targets to Reduce Risk of Suicide.

PURPOSE OF REVIEW: Suicide has a profound impact on individuals, families, and society. One prominent, if understudied, risk factor for suicide is anxiety. More than 70% of people with at least one suicide attempt meet diagnostic criteria for an anxiety disorder. There are several limitations to exploring the associations between anxiety and suicide using diagnosis-based classification systems. A better approach would be to consider transdiagnostic risk factors for anxiety. RECENT FINDINGS: Through a negative reinforcement model of suicide, anxiety sensitivity (AS) and intolerance of uncertainty (IU) appear to exacerbate the experience of unpleasant anxiety sensations and likely contribute to chronic suicide risk as well as acute suicidal acts. Although more research is needed to clarify the mechanisms through which AS and IU confer risk, brief interventions may offer an ideal suicide prevention strategy for anxious people.

Do Proximal Risk Factors Mediate the Impact of Affect on Symptoms of Generalized Anxiety Disorder and Major Depressive Disorder? An Extension of the Hierarchical Model of Cognitive Vulnerability.

BACKGROUND: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are among the most prevalent forms of psychopathology. The hierarchical model of cognitive vulnerability proposes that higher order risk factors explain co-occurrence among internalizing disorders, whereas lower order risk factors explain discordance. METHODS: Participants (N = 646; mean age = 38.50, SD = 10.00; 49.2% female) were recruited from Amazon MTurk to complete self-report questionnaires related to psychopathology in the summer of 2020. Structural equation modeling was used to examine the relations that negative affect (NA) and positive affect (PA) share with MDD and GAD, through rumination and intolerance of uncertainty (IU), cross-sectionally. RESULTS: When modeling both IU and depressive rumination together as explaining the indirect effects from affect to psychopathology, the association between NA and symptoms of MDD was explained by depressive rumination. There were no indirect effects from PA to MDD or GAD symptoms. When modeled separately, both risk factors explained the associations NA shared with MDD and GAD symptoms. CONCLUSIONS: The present study extends the hierarchical model of cognitive vulnerability by finding that depressive rumination explains the association between NA and symptoms of MDD, even when controlling for IU.

Risk factors of suicidal behaviors in a high-risk longitudinal veteran sample: A network analysis.

INTRODUCTION: Suicide is a substantial public health burden, particularly among veterans. Risk factors have been delineated for suicide; however, the dynamic interrelations between risk factors have not been fully examined. Such research has the potential to elucidate processes that contribute to suicide risk between individuals with a past suicide attempt (attempters) and those without a past suicide attempt (nonattempters). METHODS: In the current study, network analysis was used to compare networks between attempters and nonattempters in a high-risk veteran sample (N = 770; Mage  = 32.3 years, SD = 6.8; 326 with a past suicide attempt) who were followed over 1 year. Networks were estimated to examine (1) concurrent relations of suicide risk factors at baseline and (2) predictability of prospective suicidal behavior (SB). RESULTS: There were no differences in the overall connectivity of attempter and nonattempter networks. Perceived burdensomeness and posttraumatic stress disorder (PTSD) symptoms were most central in the attempters' network, whereas PTSD symptoms and insomnia were most central in the nonattempters' network. The risk factors prospective SB in either network. However, attempters were more likely to engage in SB over the course of the study. CONCLUSION: These findings highlight the difficulty in predicting who will attempt suicide.

Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD. METHODS: One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups. RESULTS: Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder. CONCLUSION: Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.

A preliminary examination of the Anxiety Sensitivity Index-3 factor structure in older adults.

BACKGROUND: Anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3), exhibits three-factor and bifactor structures for younger adults. Less is known about the scale's structure within older adult samples. METHODS: We explored the ASI-3's factor structure in a sample of 135 older adults who completed the ASI-3 alongside measures of anxiety, general worry, dementia worry, and depression as part of a larger study. Structural equation modeling was used to determine the factor structure of the ASI-3 in this sample. RESULTS: A bifactor model was identified and factor loadings supported a general factor and specific physical and cognitive subfactors, but not the social concerns subfactor. Whereas the general factor was associated with anxiety, general worry, dementia worry, and depression, each subfactor had differential associations with these mood/anxiety variables. In particular, the cognitive concerns subfactor was strongly associated with depression and dementia worry. LIMITATIONS: Generalizability of these findings is limited by a homogenous sample. CONCLUSIONS: The observed factor structure of the ASI-3 in our sample aligns with increases in physical and cognitive health concerns during aging. Associations between the cognitive concerns subfactor and dementia worry suggest that this facet of the ASI-3 may be measuring age-related health concerns rather than concerns specific to anxiety symptoms. Future studies should examine whether AS cognitive concerns and dementia worry are overlapping constructs particularly for individuals concerned about their age-related cognitive changes. Age differences in AS and its correlates should be further studied to identify better methods of assessing for AS across the lifespan.

Cognitive risk factors and the experience of acute anxiety following social stressors: An ecological momentary assessment study.

To better understand how social anxiety develops, it is crucial to identify mechanisms that influence anxiety following social stressors. Anxiety sensitivity social concerns (ASSC; fear of publicly observable anxiety symptoms) and fear of negative evaluation (FNE; distress arising from concerns about negative judgment) are constructs that amplify anxiety following social stressors. However, it is unclear how ASSC and FNE influence acute anxiety following stressors in naturalistic settings. In the current study, the impact of ASSC and FNE on anxious arousal and anxious apprehension following stressors was examined in community adults (N = 83; M age = 29.66 years, SD = 12.49, 59.0% female) who completed questionnaires five times per day for two-weeks. Dynamic structural equation modeling was used to examine predictors of overall levels of anxiety as well as anxiety following social and nonsocial stressors. ASSC interacted with the presence of social stressors, such that ASSC positively predicted anxious arousal following social stressors. FNE interacted with the presence of nonsocial stressors to predict both forms of anxiety, such that FNE positively predicted anxiety following nonsocial stressors. These findings suggest ASSC may specifically amplify anxious arousal following social stressors, whereas FNE may broadly amplify anxiety following nonsocial stressors.

Temporal dynamics of symptom change among veterans receiving an integrated treatment for posttraumatic stress disorder and substance use disorders.

The present study examined temporal patterns of symptom change during treatment for comorbid posttraumatic stress disorders (PTSD) and substance use disorders (SUDs). We hypothesized that PTSD symptom severity would predict subsequent-session substance use and that this association would be particularly strong among patients who received an integrated treatment versus SUD-only treatment. Participants were 81 United States military veterans with current PTSD and an SUD who were enrolled in a 12-week, randomized controlled trial examining the efficacy of an integrated treatment called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) compared with cognitive behavioral relapse prevention therapy (RP). Lagged multilevel models indicated that PTSD symptom improvement did not significantly predict the likelihood of next-session substance use (likelihood of use: B = 0.03, SE = 0.02, p = .141; percentage of days using B = -0.02, SE = 0.01, p = .172. Neither substance use, B = 1.53, SE = 1.79, p = .391, nor frequency of use, B = 0.26, SE = 0.50, p = .612, predicted next-session PTSD symptom severity in either treatment condition. Stronger associations between PTSD symptoms and next-session substance use were expected given the self-medication hypothesis. Additional research is needed to better understand the temporal dynamics of symptom change as well as the specific mediators and mechanisms underlying symptom change.

Distinct aspects of emotion dysregulation differentially correspond to magnitude and slope of the late positive potential to affective stimuli.

ABSTRACTEmotion dysregulation (ED) is a transdiagnostic risk factor for several forms of psychopathology. One established, integrative conceptualisation of ED that has informed our understanding of psychopathology (Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation : development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54) was recently extended to account for state-level and specifically physiological aspects of ED. As such, the goal of the current study was to assess the degree to which this conceptualisation could be captured using a physiological, state-level index (i.e. the late positive potential; LPP). Participants (N=41; Mage=27.5 years, SD=11.0) completed a trait-based rating scale measure of the extended conceptualisation of ED and viewed a series of images that ranged in valence (i.e. unpleasant, pleasant, and neutral). Multilevel modelling indicated some points of convergence between rating scale scores and the LPP, and other points of divergence. Findings underscore the utility of a multi-method approach to improve understanding of key transdiagnostic characteristics across levels of analysis. Further, results are novel evidence supporting validity of the extended conceptualisation of ED.

Anxiety sensitivity and opioid use motives among adults with chronic low back pain.

The opioid epidemic is a significant public health crisis in the United States, and chronic pain is a leading precipitating and maintaining factor for opioid misuse. To better understand substance misuse generally, research has examined motivational models of why people use substances, and pain management and affect-driven coping are cited as primary reasons for opioid misuse. Further, research examining psychosocial predictors of opioid misuse has identified anxiety sensitivity (AS; fear of anxiety-related physical sensations) as a unique predictor of opioid misuse severity, and it is possible that AS is uniquely related to opioid pain management and coping motives, which in turn, are related to opioid misuse. Therefore, the current study examined AS as a predictor of opioid pain management and coping motives, as well as the indirect effect of AS, through opioid motives, on opioid misuse status, among 292 adults (Mage = 45.76, SD = 11.20, 68.9% female) with chronic low back pain. Results for the current study support hypotheses that AS is significantly associated with pain management and coping motives (over and above variance of pain intensity) and indirectly associated with opioid misuse status through both motives. These results highlight the importance of better understanding opioid use motives in the context of chronic pain and provide potential treatment targets to add to a growing body of literature targeting psychosocial factors for opioid misuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved).