A preliminary investigation of the simultaneous effects of cannabidiol and caffeine.

Caffeine and cannabidiol (CBD) are commonly consumed by the general population, particularly among young adults; however, there is little research on the simultaneous effects of caffeine and CBD. The present study aimed to examine the simultaneous self-reported effects of caffeine and CBD in young healthy adults. Participants (N = 54) who reported daily caffeine use (> 200 mg) attended one experimental session via Zoom and were assigned randomly to receive caffeine (200 mg) combined with either a placebo or CBD (25, 50, 80, 160, or 240 mg). Participants completed subjective drug effects measures at baseline and then ingested caffeine and their assigned CBD dose. Throughout the 140-min session, participants completed self-report measures. The primary outcomes of this study were measures of general drug effects and anxiety. After caffeine and CBD administration, few effects were observed in self-reported measures of general drug effects. No negative effects emerged as a result of combined caffeine and CBD administration. These results should be interpreted cautiously given the preliminary nature and variability in outcomes. The present study findings suggest that combinations of the tested doses of caffeine and CBD do not alter subjective drug effects; further, no negative effects emerged, providing preliminary safety evidence for using these products simultaneously. Further research is needed to examine the simultaneous and/or interactive nature of caffeine and CBD on other caffeine-induced outcomes (e.g., cognition and physiological effects) and will be critical for informing future regulatory decisions regarding caffeine: CBD mixtures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A double-blind, randomized, placebo-controlled study of the safety and effects of CBN with and without CBD on sleep quality.

The present study sought to determine the effects of cannabinol (CBN) alone and in combination with cannabidiol (CBD) on sleep quality. This was a double-blind, randomized, placebo-controlled study conducted between May and November 2022. Participants were randomized to receive either (a) placebo, (b) 20 mg CBN, (c) 20 mg CBN + 10 mg CBD, (d) 20 mg CBN + 20 mg CBD, or (e) 20 mg CBN + 100 mg CBD for seven consecutive nights. Participants were 18-55 years of age who self-rated sleep quality as "very poor" or "poor." The primary endpoint was sleep quality, while secondary endpoints included sleep onset latency, number of awakenings, wake after sleep onset (WASO), overall sleep disturbance, and daytime fatigue. In a modified intent-to-treat analyses (N = 293), compared to placebo, 20 mg CBN demonstrated a nonsignificant but potentially meaningful effect on sleep quality (OR [95% CI] = 2.26 [0.93, 5.52], p = .082) and significantly reduced number of awakenings (95% CI [-0.96, -0.05], p = .025) and overall sleep disturbance (95% CI [-2.59, -0.14], p = .023). There was no difference from placebo among any group for sleep onset latency, WASO, or daytime fatigue (all p > .05). Individuals receiving 20 mg CBN demonstrated reduced nighttime awakenings and overall sleep disturbance relative to placebo, with no impact on daytime fatigue. The addition of CBD did not positively augment CBN treatment effects. No differences were observed for latency to sleep onset or WASO. Findings suggest 20 mg of CBN taken nightly may be helpful for improving overall sleep disturbance, including the number of times one wakes up throughout the night, without impacting daytime fatigue. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Two-Phase, Dose-Ranging, Placebo-Controlled Study of the Safety and Preliminary Test of Acute Effects of Oral Δ8-Tetrahydrocannabivarin in Healthy Participants.

Introduction: Tetrahydrocannabivarin (THCV) is an understudied cannabinoid that appears to have effects that vary as a function of dose. No human study has evaluated the safety and nature of effects in a wide range of THCV doses. Methods: This was a two-phase, dose-ranging, placebo-controlled trial of the Δ8 isomer of oral THCV in healthy adults. Phase 1 utilized an unblinded, single-ascending dose design (n=3). Phase 2 used a double-blind, randomized, within-participant crossover design (n=18). Participants received single acute doses of placebo and 12.5, 25, 50, 100, and 200 mg of THCV. Safety measures and subjective and cognitive effects were assessed predose and up to 8 h postdose. Results: Most adverse events (AEs; 55/60) were mild. Euphoric mood was the most common AE. The 12.5, 25, and 200 mg doses produced significantly lower minimum times to complete the digit vigilance test (ps=0.01). The 25 mg dose showed elevations on mean ratings of "energetic" at 1-, 2-, and 4-h postdose, but the maximum postdose rating for this dose did not achieve statistical significance relative to placebo ([95% confidence interval]=3.2 [-0.5 to 6.9], p=0.116). The 100 and 200 mg doses showed elevations on ratings of "feel a drug effect" and "like the drug effect." Almost all urine drug screens (78/79) at 8 h postdose in the active THCV conditions tested positive for tetrahydrocannabinol (THC). Conclusion: All THCV doses displayed a favorable safety profile. Several THCV doses showed a preliminary signal for improved sustained attention, but the effect was not dose dependent. Though mild and not associated with impairment, THC-like effects were observed at higher THCV doses. Oral THCV-containing products could lead to positive urine drug screens for THC. ClinicalTrials.gov ID: NCT05210634.

Cannabidiol Reduces Nicotine Withdrawal Severity and State Anxiety During an Acute E-cigarette Abstinence Period: A Novel, Open-Label Study.

Introduction: Despite efforts to curb nicotine use, 8.1 million adults in the United States use e-cigarettes. Notably, the majority of nicotine-containing e-cigarette users report wanting to quit in the near future, yet there is a dearth of research surrounding intervention efforts. Cannabidiol (CBD) has potential to facilitate e-cigarette quit attempts by decreasing withdrawal symptom intensity and anxiety during nicotine e-cigarette abstinence. Methods: This study employed an open-label, crossover design (n=20) to test the hypothesis that among daily nicotine-containing e-cigarette users, oral administration of 320 mg CBD would reduce self-reported nicotine withdrawal severity and state anxiety following a 4-h e-cigarette abstinence period compared to withdrawal and anxiety reported after abstinence in the absence of CBD. Results: After controlling for participants' positive CBD expectancies, results were consistent with hypotheses, suggesting CBD reduced both nicotine withdrawal symptom severity and state anxiety during e-cigarette abstinence. Conclusion: These preliminary findings suggest testing the impact of CBD on e-cigarette cessation attempts is warranted.

A crowdsourcing survey study on the subjective effects of delta-8-tetrahydrocannabinol relative to delta-9-tetrahydrocannabinol and cannabidiol.

Delta-8-tetrahydrocannabinol (Δ8-THC) has emerged as a new retail cannabinoid product in the U.S. This study queried Δ8-THC users about product use characteristics and self-reported drug effects. Participants were recruited via a large online crowdsourcing platform (Amazon Mechanical Turk). Adults (N = 252) with past year Δ8-THC use (35% with at least weekly use) completed surveys and open-ended questions related to their reasons for using and past experiences with Δ8-THC-containing retail products. Participants with past year use of Δ9-tetrahydrocannabinol (Δ9-THC) and/or cannabidiol (CBD; 81% and 63%) compared the effects of Δ8-THC to those of Δ9-THC and/or CBD by rating drug effects on a visual analog scale from -50 to + 50 where negative scores indicated Δ8-THC effects are weaker, positive scores indicated Δ8-THC effects are stronger, and a score of 0 indicated equal effects to Δ9-THC or CBD. Compared to Δ9-THC, self-reported ratings for "Drug effect," "Bad effect," "Sick," "Anxiety," "Paranoia," "Irritability," "Restlessness," "Memory Problems," and "Trouble Performing Routine Tasks" were lower for Δ8-THC (d = -0.21 to -0.44). Compared to CBD, ratings for Δ8-THC effects were higher for "Drug effect," "Good effect," "High," "Relaxed," "Sleepy," "Hunger/Have the Munchies," "Memory Problems," "Trouble Performing Routine Tasks," and "Paranoia" (d = 0.27-1.02). Qualitative responses indicated that participants used Δ8-THC because it is perceived as (a) legal, (b) a substitute or similar to Δ9-THC, and/or (c) less intense than Δ9-THC. Δ8-THC is an understudied psychoactive component of cannabis that shares more characteristics with Δ9-THC than CBD and should be characterized further with human laboratory studies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A laboratory-based examination of a standardized sexual assault script.

BACKGROUND AND OBJECTIVE: Idiographic script-driven imagery is core to both research and treatment related to posttraumatic stress disorder (PTSD), including among individuals with a history of sexual assault. However, there may be benefit in having alternatives to such idiographic techniques. The current study therefore examined multimodal responding to a standardized audio-recorded narrative of a sexual assault. DESIGN AND METHOD: In this experiment, 105 women (Mage = 19.09, SD = 2.24) were recruited from the community and randomly assigned to listen to a depiction of sexual assault (trauma condition) or a similar experience without sexual assault (control condition). RESULTS: As hypothesized, relative to the control group, participants in the trauma condition reported greater (a) increases in anxiety, anger, and disgust from pre- to post- manipulation, and (b) distress across the duration of the recording. In contrast to hypotheses, heart-rate did not differ across groups. CONCLUSIONS: Results suggest listening to a standardized sexual assault narrative, compared to a non-traumatic narrative, effectively increases negative affect. This indicates standardized sexual assault narratives have potential as a traumatic event cue presentation method both for trauma-focused treatment and studying reactions to sexual assault cues.

Longitudinal Relationship between the Introduction of Medicinal Cannabis and Polypharmacy: An Australian Real-World Evidence Study.

Background: Recent studies recommend medicinal cannabis (MC) as a potential treatment for chronic pain (CP) when conventional therapies are not successful; however, data from Australia is limited. This real-world evidence study explored how the introduction of MC related to concomitant medication use over time. Long-term safety also was examined. Methods: Data were collected by the Emerald Clinics (a network of seven clinics located across Australia) as part of routine practice from Jan 2020 toJan 2021. Medications were classified by group: antidepressants, benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and total number of medications. Adverse events (AEs) were collected at each visit and subsequently coded using the Medical Dictionary for Regulatory Activities version 23 into the system organ class (SOC) and preferred term (PT). A total of 535 patients were analyzed. Results: The most common daily oral dose was 10 mg for delta-9-tetrahydrocannabinol (THC) and 15 mg for cannabidiol (CBD). With the introduction of MC, patients' total number of medications consumed decreased over the course of one year; significant reductions in NSAIDs, benzodiazepines, and antidepressants were observed (p < .001). However, the number of prescribed opioid medications did not differ from baseline to the end of one year (p = .49). Only 6% of patients discontinued MC treatment during the study. A total of 600 AEs were reported in 310 patients during the reporting period and 97% of them were classified as nonserious. Discussion. Though observational in nature, these findings suggest MC is generally well-tolerated, consistent with the previous literature, and may reduce concomitant use of some medications. Due to study limitations, concomitant medication reductions cannot be causally attributed to MC. Nevertheless, these data underscore early signals that warrant further exploration in randomized trials.

A double-blind, randomized, placebo-controlled test of the effects of cannabidiol on fear elicited by a 10% carbon dioxide-enriched air breathing challenge.

OBJECTIVE: A single administration of cannabidiol (CBD) can reduce anxiety during social anxiety inductions. No study, however, has evaluated the impact of CBD on fear responding among humans. METHOD: A double-blind, randomized, placebo-controlled trial was undertaken to address this gap in the literature. Specifically, the current study tested a single oral administration of CBD (either 150 mg, 300 mg, or 600 mg), compared to placebo, for reducing fear reactivity to a well-established 5-min administration of 10% carbon dioxide (CO2)-enriched air biological challenge. CBD was administered 90 min prior to the challenge. Participants were 61 healthy young adults who self-reported fear continuously during the challenge. Heart rate also was continuously monitored, and panic symptoms were self-reported using the Diagnostic Sensations Questionnaire immediately following the procedure. RESULTS: Results indicated no effect of condition on self-reported fear, panic symptoms, or heart rate. CONCLUSION: This is the first study to document that CBD does not reduce fear reactivity in humans, thereby representing an important extension to research on the effects of CBD.

Medical cannabis authorization patterns, safety, and associated effects in older adults.

BACKGROUND: Use of medical cannabis is increasing among older adults. However, few investigations have examined cannabis use in this population. METHODS: We assessed the authorization patterns, safety, and effects of medical cannabis in a sub-analysis of 201 older adults (aged ≥ 65 years) who completed a 3-month follow-up during this observational study of patients who were legally authorized a medical cannabis product (N = 67). Cannabis authorization patterns, adverse events (AEs), Edmonton Symptom Assessment Scale-revised (ESAS-r), and Brief Pain Inventory Short Form (BPI-SF) data were collected. RESULTS: The most common symptoms for which medical cannabis was authorized were pain (159, 85.0%) and insomnia (9, 4.8%). At baseline and at the 3-month follow-up, cannabidiol (CBD)-dominant products were authorized most frequently (99, 54%), followed by balanced products (76, 42%), and then delta-9-tetrahydrocannabinol (THC)-dominant products (8, 4.4%). The most frequent AEs were dizziness (18.2%), nausea (9.1%), dry mouth (9.1%), and tinnitus (9.1%). Significant reductions in ESAS-r scores were observed over time in the domains of drowsiness (p = .013) and tiredness (p = .031), but not pain (p = .106) or well-being (p = .274). Significant reductions in BPI-SF scores over time were observed for worst pain (p = .010), average pain (p = .012), and overall pain severity (p = 0.009), but not pain right now (p = .052) or least pain (p = .141). CONCLUSIONS: Overall, results suggest medical cannabis was safe, well-tolerated, and associated with clinically meaningful reductions in pain in this sample of older adults. However, the potential bias introduced by the high subject attrition rate means that all findings should be interpreted cautiously and confirmed by more rigorous studies.

An experimental test of the effects of acute sleep deprivation on affect and avoidance.

BACKGROUND AND OBJECTIVES: Avoidance and sleep have been identified as mechanisms involved in the development and maintenance of many mental health disorders. However, there has been little research into the relation between sleep and avoidance. METHODS: To address this, a randomized controlled experiment using behavioral and self-report measures of affect and avoidance was conducted. Compared to a control group, we hypothesized that sleep-deprived individuals would demonstrate increased negative, and decreased positive, affectivity, more avoidance behavior toward a negatively valenced stimulus, as well as increased self-reported avoidance. Fifty-two healthy individuals ages 18-30 years old were randomly assigned to a full night of sleep deprivation or normal sleep. They completed a baseline and post-manipulation behavioral avoidance task (BAT) using a disgusting stimulus and self-reports of avoidance and state affect. RESULTS: Repeated measures ANOVAs demonstrated negative affectivity and self-reported avoidance increased, and positive affectivity decreased, from pre-to post-manipulation in the sleep loss condition as expected. However, there were no effects of sleep deprivation on avoidance behaviors. LIMITATIONS: This study emphasized internal validity over generalizability. Additionally, the at-home sleep deprivation limited researcher control over the overnight activities of participants. CONCLUSIONS: Results replicate prior work on the affective consequences of sleep deprivation and highlight a discrepancy between the effect of sleep deprivation on behavioral avoidance toward a specific stimulus compared to self-reported cognitive and social avoidance behaviors.

Greater adolescent tiredness is related to more emotional arousal during a hyperventilation task: An area under the curve approach.

INTRODUCTION: Approximately 36% of adolescents report sleep problems (Crowley et al., 2018). Understanding the relation between sleep and emotional experience is crucial in understanding the high incidence of mental health concerns during adolescence. The current study sought to expand understanding in the area by testing the hypothesis that baseline tiredness ratings would predict greater emotional arousal and negative valence across the course of emotional response elicited by a voluntary hyperventilation procedure. METHODS: A community sample of 110 youth (10-18 years; 47.8% girls) provided baseline tiredness ratings and ratings of emotional valence and arousal, 2 min before, immediately after, and 3 min after a hyperventilation task. The area under the curve (AUC) was calculated using the repeated measures of valence and arousal, and correlations between the response curves and baseline tiredness were examined. RESULTS AND CONCLUSIONS: Findings indicated baseline tiredness was positively associated with AUC arousal (r = 0.23), but not valence. This suggests daytime tiredness is associated with the degree of emotional arousal elicited by a psychobiological stressor. By extension, adolescents may experience more arousing emotional reactions when tired, and thus the common sleep deprivation observed during this developmental period may increase risk for mental health problems associated with elevated emotional reactivity.

Practical considerations for testing the effects of cannabidiol on human anxiety.

Empirical evidence continues to accumulate suggesting cannabidiol (CBD) may have potential as an anxiolytic. Yet, research in the area is insufficient to support strong inferences. Accordingly, there is a need for additional empirical investigation. Research on the effects of CBD and anxiety requires a working knowledge of both. Understanding of contemporary CBD and anxiety research methods is critical to safely and convincingly test predictions regarding potential anxiolytic effects of CBD. The current paper outlines major design, methods, and safety considerations pertinent both to CBD administration and measuring effects on anxiety outcomes in order to facilitate needed research in this domain.

Incorporating telehealth into health service psychology training: A mixed-method study of student perspectives.

OBJECTIVE: Telehealth is increasingly recognized as an avenue for enhancing psychologists' capacities to meet the mental health needs of a diverse and underserved (due to barriers e.g., distance, transportation) public. The present study sought to inform training in telepsychology (i.e., telehealth delivery of psychological services) by using both quantitative and qualitative methods to explore the perspectives of doctoral students who have already been involved in such training. METHOD: A total of 19 predoctoral students from two universities, with at least some experience in telepsychology training, provided their perspectives on two complementary research questions: (1) How do students perceive their level of competence in various domains of telepsychology?; and (2) What are students' perspectives on the process of telepsychology competency development during their doctoral training? RESULTS: The results of our study provide early evidence that doctoral trainees are able to develop telepsychology competencies and suggest that a supportive, training-oriented environment and fit between telepsychology and existing programmatic areas of emphasis are likely key to success. CONCLUSIONS: Continued efforts to enhance training in providing telepsychology services should focus on how to best define, measure, and promote competency development in this emerging specialty area.

Hippocampal volume recovery with real-time functional MRI amygdala neurofeedback emotional training for posttraumatic stress disorder.

BACKGROUND: Small hippocampal volume is a prevalent neurostructural abnormality in posttraumatic stress disorder (PTSD). However, whether the hippocampal atrophy is the cause of disease symptoms or a pre-existing risk factor and whether it is a reversible alteration or a permanent trait are unclear. The trait- or state-dependent alteration could also differ among the hippocampal subfields. METHODS: The study examined the longitudinal hippocampal volume changes due to positive emotional training with left amygdala (LA) real-time fMRI neurofeedback (rtfMRI-nf) in combat veterans with PTSD. The participants were trained to increase the neurofeedback signal from LA (experimental group, N = 20) or brain region not involved in emotion processing (control group, N = 9) by recalling a positive autobiographical memory. The pre- and post-training structural MRI brain images were processed with FreeSurfer to evaluate the hippocampal subfield volumes. Hippocampal volumes for healthy controls (N = 43) were also examined to evaluate the baseline abnormality in PTSD. RESULTS: A significant group difference in volume change was found in the left CA1 head region. This region had the most significant volume reduction at the baseline in PTSD. The experimental group showed a significant volume increase, while the control group showed a significant volume decrease in this region. The volume change in the control group negatively correlated with interval days between the scans. LIMITATIONS: A cognitive improvement due to the hippocampal volume increase could not be found with symptom scales. CONCLUSIONS: RtfMRI-nf positive emotional training increased the hippocampus volume among people with PTSD, suggesting that hippocampal atrophy in PTSD is modifiable.

Test of an Anxiety Sensitivity Amelioration Program for at-risk youth (ASAP-Y).

OBJECTIVE: Adult research supports the efficacy of targeting the malleable risk factor of anxiety sensitivity (AS) in preventing anxiety and related psychopathology. However, very little work has evaluated the impact of AS reduction among youth, which is unfortunate given adolescence is a "core risk" period in terms of disorder onset. METHOD: The primary project aim was to test the effects of an Anxiety Sensitivity Amelioration Program for Youth (ASAP-Y) among a sample of 88 youth aged 10-14 years with elevated AS. High AS youth and a parent were randomly assigned to either the ASAP-Y, which consisted of psychoeducation and experimenter-led and parent-led exposures, or a general health information control condition. RESULTS: Youth in the intervention condition sustained low AS levels across the intervention period, and although AS levels in both conditions decreased from baseline to the one-month assessment, this decrease was more pronounced at one-month for youth in the intervention condition. Further, significant indirect effects of condition on one-month anxiety and depression symptoms via reduced AS were detected. Homework compliance rates and self-report data support the acceptability of the ASAP-Y. Contrary to hypotheses, differences between conditions in emotional reactivity elicited using experimental psychopathology methods were not observed. CONCLUSIONS: The current findings offer preliminary support for the ASAP-Y as an acceptable selective preventive intervention for at-risk youth, with specific anxiety- and depression-related effects through reduced AS.

Distress Tolerance Interacts with Peritraumatic Emotions to Predict Posttraumatic Stress Symptoms Following Sexual Victimization.

The intensity of peritraumatic emotions occurring at the time of, and in the hours or days immediately following, a traumatic event prospectively predicts posttraumatic stress symptom severity. However, less is known about how the perception of one's ability to tolerate distressing emotions affects the relation between peritraumatic emotions and posttraumatic stress symptoms. Therefore, the current study investigated how perceived distress tolerance affects the association between peritraumatic emotional intensity and symptoms of posttraumatic stress. Participants included 72 adult women with a history of sexual victimization. Ratings of peritraumatic emotions (e.g., fear, anger, sadness, guilt, and shame), perceived distress tolerance, and posttraumatic stress symptoms were examined. All analyses controlled for general negative affect. Significant interactions emerged for overall peritraumatic emotional intensity, and specifically for peritraumatic anger, sadness, and shame. The associations between these peritraumatic emotions and posttraumatic stress symptoms were stronger for individuals with lower perceived ability to tolerate distress. Our results suggest that peritraumatic emotional experiences may be particularly relevant to understanding the development and maintenance of posttraumatic stress symptoms among individuals who have difficulty tolerating intense negative emotional states. Future research should examine whether perceived distress tolerance might serve as a potential target for posttraumatic stress prevention efforts.

Shame Proneness, Negative Cognitions, and Posttraumatic Stress Among Women with a History Sexual Trauma.

While fear and anger have been extensively studied as emotions involved in posttraumatic stress disorder, shame is an important emotion to examine in those who have experienced a traumatic event, as it is often associated with treatment avoidance and treatment resistance. Compared to guilt, which is associated with having participated in something that violates social/cultural norms or expectations, shame is associated with a negative perception of the self. The current paper sought to examine the role of shame proneness and guilt proneness, as it relates to posttraumatic cognitions and posttraumatic stress symptoms (PTSS) among women reporting a history of sexual trauma. Seventy-two community-recruited women with a history of sexual trauma completed self-report measures of shame and guilt proneness and negative posttraumatic cognitions as well as a semi-structured interview assessing PTSS. There was an indirect effect of shame proneness on PTSS, through its positive association with negative cognitions about the self but not others or the world. Guilt proneness was not significantly related to PTSS or negative posttraumatic cognitions. The current paper outlines the importance of these findings and future directions for continuing to better understand the relations between shame and posttraumatic stress disorder symptoms and treatment.

Brain activity mediators of PTSD symptom reduction during real-time fMRI amygdala neurofeedback emotional training.

Self-regulation of brain activation with real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) is emerging as a promising treatment for psychiatric disorders. The association between the regulation and symptom reduction, however, has not been consistent, and the mechanisms underlying the symptom reduction remain poorly understood. The present study investigated brain activity mediators of the amygdala rtfMRI-nf training effect on combat veterans' PTSD symptom reduction. The training was designed to increase a neurofeedback signal either from the left amygdala (experimental group; EG) or from a control region not implicated in emotion regulation (control group; CG) during positive autobiographical memory recall. We employed a structural equation model mapping analysis to identify brain regions that mediated the effects of the rtfMRI-nf training on PTSD symptoms. Symptom reduction was mediated by low activation in the dorsomedial prefrontal cortex (DMPFC) and the middle cingulate cortex. There was a trend toward less activation in these regions for the EG compared to the CG. Low activation in the precuneus, the right superior parietal, the right insula, and the right cerebellum also mediated symptom reduction while their effects were moderated by the neurofeedback signal; a higher signal was linked to less effect on symptom reduction. This moderation was not specific to the EG. MDD comorbidity was associated with high DMPFC activation, which resulted in less effective regulation of the feedback signal. These results indicated that symptom reduction due to the neurofeedback training was not specifically mediated by the neurofeedback target activity, but broad regions were involved in the process.

An evaluation of the validity of a script-driven imagery procedure among traumatic event-exposed adolescents.

OBJECTIVE: Adult research employing script-driven imagery procedures has shown the method to be a valuable tool for studying the nature, correlates, and consequences of trauma and posttraumatic stress symptoms (PTSS). The purpose of the current study was to examine the validity of a trauma-focused script-driven imagery procedure among youth. METHOD: Responding to script-driven imagery was examined in relation to PTSS among 60 traumatic event-exposed adolescents, ages 10 to 17 years. RESULTS: In support of concurrent validity, PTSS was associated with self-reported anxiety, fear, disgust, and distress responses to the script. Script-elicited reexperiencing, dissociation, and total state-symptoms were associated with interview-measured severity of PTSS. However, neither script-elicited avoidance symptoms nor physiological reactivity to the script were related to PTSS. In support of discriminant validity, adolescents' self-reported thought problems were not related to script-elicited affective, physiological, or state-symptom outcomes. CONCLUSION: Research is needed to understand why certain variables, such as physiological reactivity to the script, did not relate to PTSS. However, results suggest the traumatic event-focused script driven imagery procedure is a useful method for activating a trauma-related emotion network and measuring psychological reactivity to reminders of traumatic event cues among adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Lethality of Previous Suicidal Behavior among Patients Hospitalized for Suicide Risk Predicts Lethality of Future Suicide Attempts.

OBJECTIVE: A suicide attempt is an established risk factor for subsequent suicide attempts and suicide. Nonetheless, the prediction of future suicidal behavior is poor. The lethality of previous suicidal behavior may be informative to better understand future suicide risk among patients hospitalized for suicidal thoughts and behavior. The current study examined whether the lethality of patients' index (most recent suicidal episode at hospitalization), first, and worst suicidal episode predicts the lethality of one's most lethal suicide attempt during a 2-year follow-up period. METHOD: A total of 98 patients hospitalized at an emergency department for high suicide risk (i.e., acute suicidal ideation or a suicide attempt) were included in the study. RESULTS: Results indicated that the lethality of the index suicidal episode predicted the lethality of the worst suicide attempt during a 2-year follow-up period. CONCLUSIONS: These findings extend a growing literature examining risk factors that influence the progression toward high lethality suicidal behavior.