Transitioning to college: Testing cognitive bias modification for interpretations as an inoculation tool for social anxiety in college first-years.

BACKGROUND AND OBJECTIVES: Reducing social anxiety development among incoming college students may improve college adjustment and mental health outcomes. This study tested whether cognitive bias modification for interpretations (CBM-I) reduces social anxiety and increases adjustment during the transition to college, and whether changes in outcomes would be mediated by changes in interpretation biases. METHODS: Participants (N = 73) were randomly assigned to a 3-session weekly CBM-I condition or symptom tracking (ST) control condition. Multilevel models were used to estimate within-person trajectories from baseline to one week post-intervention and to test whether trajectories differed by condition. RESULTS: Those in the CBM-I condition (vs. ST) reported higher increases in social adjustment across time. There were not significant differences between conditions for changes in social anxiety, academic adjustment, and personal adjustment. CBM-I was indirectly linked to improvements in outcome variables via more adaptive interpretation biases. LIMITATIONS: CBM-I was administered in a laboratory setting, requiring more resources than some computerized interventions. CONCLUSIONS: Data tentatively support CBM-I for first-year students to increase social adjustment. Further, mediation findings provide support for targeting interpretation biases to improve social anxiety and adjustment outcomes. Yet, CBM-I did not outperform ST in improving social anxiety symptoms or other areas of college adjustment, and effect sizes were small, suggesting that more work is needed to amplify the potential of CBM-I as a therapeutic tool.

Cognitive behavioral therapy for anxiety and opioid use disorder: Development and pilot testing.

INTRODUCTION: Anxiety disorders are highly prevalent among people with opioid use disorder (OUD), and they have a negative impact on disorder course and treatment outcomes. The objective of this Stage 1 A/1B behavioral treatment development trial was to develop a novel cognitive-behavioral therapy (CBT) protocol for co-occurring anxiety disorders and OUD. METHODS: Following a period of iterative manual development involving patient interviews and feedback from content experts, we tested a 12-session individual CBT protocol in a small, open pilot trial (N = 5). This was followed by a small, randomized controlled trial (N = 32), comparing the new protocol to 12 sessions of manualized Individual Drug Counseling. All participants also received medication for OUD. RESULTS: Overall, support for feasibility and acceptability was strong, based on recruitment and retention rates and patient satisfaction ratings. Within-subjects results identified 11-point reductions in anxiety symptom severity (on a 0-56 point scale); these gains were sustained through 3 months of follow-up. However, these changes did not differ between randomized conditions. With respect to opioid outcomes, 85 % of participants were abstinent in the prior month at the end of treatment. Opioid use outcomes also did not differ by treatment condition. CONCLUSIONS: These results support the feasibility and acceptability of a CBT protocol for co-occurring anxiety and OUD. However, in this small pilot trial results do not show an initial benefit over an evidence-based psychosocial treatment targeted to OUD alone, in combination with medication for OUD.

Following social media influencers who share alcohol-related content is associated with college drinking.

INTRODUCTION: Frequent exposure to peer-shared alcohol-related content (ARC) on social media is associated with greater alcohol consumption and related consequences among undergraduates. Social media influencers also share ARC; yet, the effect of exposure to influencer-shared ARC on alcohol outcomes has not been examined. The current study examined whether following influencers who share ARC and the frequency of sharing were associated with alcohol outcomes, and associations between influencer type (e.g., actors) and alcohol outcomes. METHODS: Undergraduates (N = 528) from two universities in the United States completed an online survey assessing demographics, social media use, alcohol use and related consequences. They listed up to five influencers they followed and viewed the most content from. A series of linear regression models were conducted. RESULTS: Having a larger proportion of influencers sharing ARC was associated with greater quantity, frequency and peak drinks, but not consequences. Frequency of influencers sharing ARC was associated with greater quantity and peak drinks, but not frequency or consequences. Findings remained significant, even after controlling for peer ARC. Actor ARC, everyday person ARC and 'other' type influencer ARC were associated with several alcohol outcomes. DISCUSSION AND CONCLUSIONS: This study added to the literature by examining how following influencers who share ARC, and sharing frequency, were associated with drinking outcomes over and above exposure to peer ARC. It also examined whether ARC content from specific types of influencers was associated with alcohol outcomes. Findings highlight that the source of ARC is relevant when studying the effects of ARC exposure on college drinking.

Distressed Drinking: The Moderating Impact of Distress Tolerance on the Relation Between Anxiety Sensitivity, Panic Symptoms, and Alcohol Use and Problems.

OBJECTIVE: Undergraduate students are at particular risk for greater alcohol use, which is linked to anxiety disorders among a variety of other negative consequences. Understanding transdiagnostic factors underlying alcohol use problems and other disorders, such as anxiety and mood disorders, can help identify potential targets for intervention. METHOD: The present study (N = 208 undergraduates; 76.9% female) tested relations between self-reported anxiety sensitivity, panic symptoms, alcohol use and problems, and two different measures of distress tolerance. Specifically, the distress tolerance measures assessed (a) perceived ability to handle negative emotion states (emotional distress tolerance), measured via self-report, and (b) behavioral ability to tolerate discomforting physical sensations (physical distress tolerance), measured via a breath-holding duration task. RESULTS: Consistent with expectations, anxiety sensitivity was associated with greater panic symptoms, which in turn was associated with greater alcohol use problems, for individuals with low but not high levels of physical distress tolerance. Contrary to expectations, there was no evidence that panic symptoms explained the relation between anxiety sensitivity and alcohol use and problems at either low or high levels of emotional distress tolerance. CONCLUSIONS: Taken together, these results suggest that a possible target to decrease alcohol use problems is to increase capacity to withstand or engage with discomforting physiological and panic sensations (i.e., to cultivate greater physical distress tolerance).

Why am I craving? The role of elaboration on ambiguous desire states.

Objective: We examined how attributions of broad ambiguous desire symptoms (eg, irritability) and elaborations on specific substances (ie, caffeine/food) influence subsequent self-reported cravings for these substances. Participants: 346 undergraduates were randomized to attribute their ambiguous desire symptoms to a lack of caffeine, food, or a vacation (active control), and then elaborate on the assigned stimulus. There was also a no-elaboration control group. Methods: Generalized Linear Models were used to test whether elaborating on one substance would increase cravings for that substance and decrease craving for the unelaborated substance relative to controls. Results: Participants who elaborated in terms of food reported increased food cravings, whereas participants who elaborated in terms of caffeine reported increased caffeine cravings. Conclusions: Findings suggest that food and caffeine cravings are malleable, and point to the importance of elaboration in polysubstance contexts. Food and caffeine elaborations may matter for heightening craving and determining the targets of craving.

Anxiety sensitivity and panic symptoms: the moderating influence of distress tolerance.

BACKGROUND AND OBJECTIVES: Anxiety sensitivity (AS) is the fear of consequences of anxiety-related sensations, and has been linked to the development of panic symptoms. Distress tolerance (DT) encompasses one's behavioral or self-perceived ability to handle aversive states. We examined whether higher DT buffers the relationship between AS and changes in panic symptoms across two timepoints, spaced ∼three weeks apart. DESIGN AND METHODS: At Time 1, 208 participants completed questionnaires and a physical DT task (breath-holding duration), a cognitive DT task (anagram persistence), and a self-report measure of DT (perceived DT). Panic symptoms were assessed at both timepoints. Structural equation modeling was used to evaluate two models in which AS and DT predicted changes in panic. RESULTS: Contrary to hypotheses, for those with longer breath-holding duration (higher physical DT), higher fears of physical anxiety-related sensations (higher physical AS) were associated with worse panic outcomes over time. CONCLUSIONS: Findings suggest that those with lower physical DT may have been less willing to engage with difficult tasks in the short-term. Although disengagement in the short-term may provide temporary relief, it is possible that averse psychopathological consequences stemming from rigid or habitual avoidance of distressing states may develop over longer periods of time.

A pilot study of benzodiazepine cue-induced craving.

OBJECTIVES: The misuse of benzodiazepines is a growing concern due to increases in both access to these medications and their associated public health harms, most concerningly risk for overdose when combined with other substances. Although cue reactivity-the subjective and physiological response to cues or reminders of substance use-has been identified for most major classes of substances, it has yet to be studied with benzodiazepines. In this preliminary study, our objective was to assess whether images of benzodiazepines were associated with greater craving and anxiety than neutral images in adults who reported misuse of benzodiazepines. METHODS: We recruited a sample of 38 adults from a substance use disorder treatment setting and administered a standard cue reactivity task using pictorial images along with a battery of self-report measures. RESULTS: Results indicated significantly higher craving and anxiety in response to benzodiazepine relative to neutral cues, with cues eliciting a moderate to high level of craving, on average. Craving was associated with several risk factors for benzodiazepine misuse, including insomnia and distress intolerance. CONCLUSIONS: This preliminary study suggests that benzodiazepine cues can become conditioned to elicit craving responses and that the degree of cue reactivity is correlated with known risk factors for benzodiazepine misuse.

Sex differences in benzodiazepine misuse among adults with substance use disorders.

Women are more likely than men to be diagnosed with anxiety disorders and to be prescribed benzodiazepines. People with substance use disorders are at a heightened risk for the misuse of benzodiazepines, yet little is known about sex differences in the prevalence, correlates or patterns of benzodiazepine misuse in this population. The aim of this study was to characterize sex differences in benzodiazepine misuse in a sample of adults receiving substance use disorder treatment (N = 352). Almost half of the sample had been prescribed a benzodiazepine and more than 40% had misused a benzodiazepine. Women were more likely to have a lifetime prescription than men, but were not more likely to report misuse or regular misuse. Consistent with data for other substances, women were more likely to report misusing benzodiazepines to cope and reported greater anxiety sensitivity. The vast majority (97%) of participants reported co-use of benzodiazepines with other substances and 65% of women reporting misusing benzodiazepines via a non-oral route of administration (e.g., intranasal). Although benzodiazepine misuse prevalence was not substantively different between men and women, several sex differences in clinical characteristics and patterns of use were identified. Further research on the nature of sex differences in benzodiazepine misuse is needed to inform targeted treatment for both men and women with substance use disorders.