A laboratory-based test of the relation between adolescent alcohol use and panic-relevant responding.

A burgeoning literature supports a link between alcohol use and panic-spectrum problems (e.g., panic attacks, disorder) among adolescents, but the direction of influence has yet to be properly examined. From a theoretical perspective, panic-spectrum problems may increase risk for problematic drinking via affect regulation efforts (e.g., self-medication), and problematic consumption also may increase or initiate panic-relevant responding (e.g., learning or kindling models). The objective of the current investigation was to examine the role of prior alcohol use in predicting panic-relevant responding, as well as panic symptom history in predicting the desire to consume alcohol, in the context of either a voluntary hyperventilation or a low-arousal task. Participants were community-recruited adolescents aged 12-17 years (n = 92, Mage = 15.42, SD = 1.51; 39.1% girls). Results indicated that prior alcohol use predicted panic-relevant responding among those undergoing the hyperventilation task (but not the low-arousal task), and that this finding was robust to the inclusion of theoretically relevant covariates (i.e., age, sex, negative affectivity). However, panic symptom history did not predict the desire to consume alcohol as a function of either the hyperventilation or low-arousal condition. This work sheds further light on the nature of the relation between panic-spectrum problems and problematic alcohol use in adolescence. Specifically, the current findings suggest that frequent alcohol use may increase panic vulnerability among adolescents, whereas acute panic symptoms may not elicit the immediate (self-reported) desire to drink.

An experimental test of the effects of parental modeling on panic-relevant escape and avoidance among early adolescents.

Escape and avoidance behaviors play a prominent role in the maintenance and possibly development of panic disorder, yet the literature regarding the etiology of these emotion-regulation strategies is relatively underdeveloped. The current study experimentally tests hypotheses that parental modeling of escape during a well-established panic-relevant biological challenge increases panic-relevant escape and avoidance among offspring. Fifty physically and psychologically healthy early adolescents (28 females; Mage=11.58; 86% Caucasian), stratified by gender, were randomly assigned to observe one of their parents (39 females; Mage=40.04): either (a) model completing a 3-min voluntary hyperventilation exercise (no escape modeling group) or (b) model premature termination of a similar procedure (escape modeling group). Offspring in the escape modeling group demonstrated a stronger escape response by discontinuing their own challenge sooner than those in the no-escape modeling group (r=.70). No group differences emerged in terms of avoidance responding, as indexed by nearly identical responding in terms of delay time before initiating the challenge, respiration rate, and self-reported willingness to engage in a second proposed challenge. Results suggest that parental behaviors may play an important role in the development of some forms of panic-relevant responding. These preliminary findings may have important implications for future prevention programs targeting parents and at-risk youth.

Offspring psychological and biological correlates of parental posttraumatic stress: review of the literature and research agenda.

Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.

The relationship of sleep quality and PTSD to anxious reactivity from idiographic traumatic event script-driven imagery.

Poor sleep quality has been linked to posttraumatic stress disorder (PTSD). This study provided a test of how poor sleep quality relates to real-time assessment of anxious reactivity to idiographic traumatic event cues. Script-driven imagery (SDI) was employed to examine reactivity to traumatic event cues among 46 women (mean age = 27.54 years, SD = 13.62; 87% Caucasian) who had experienced either physical or sexual assault. We tested 3 hypotheses: (a) individuals with PTSD would report greater anxiety reactions to SDI than trauma-exposed individuals without PTSD, (b) poorer sleep quality would be positively related to anxiety reactions to SDI, and (c) there would be an interaction between PTSD and sleep quality such that individuals with PTSD and relatively poor sleep quality would report greater anxious reactivity to SDI than would be expected from each main effect alone. Poor sleep quality and PTSD were related to elevated anxious reactivity to trauma cues (sr(2) = .06). In addition, sleep quality was negatively associated with anxious reactivity among people without PTSD (sr(2) =.05). The current findings, in combination with longitudinal evidence, suggest that poor sleep quality following exposure to a traumatic event may be a risk factor for anxious reactivity to traumatic event cues.

Specificity of fear and disgust experienced during traumatic interpersonal victimization in predicting posttraumatic stress and contamination-based obsessive-compulsive symptoms.

Emerging evidence has documented comorbidity between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) among individuals with a history of traumatic events. There is growing recognition of the importance of disgust in each of these conditions independently. No study, however, has examined the potential role of disgust in these conditions following traumatic event exposure. The current study examined the unique role of peritraumatic fear, self-focused disgust, and other-focused disgust in predicting posttraumatic stress symptoms and contamination-based OC symptoms among 49 adult women (M(age)=28.37, SD=13.86) with a history of traumatic interpersonal victimization. Results demonstrated that intensity of peritraumatic self-focused disgust was significantly related to contamination-based OC symptoms while peritraumatic fear and other-focused disgust were related to posttraumatic stress symptoms. These results highlight the need for future research aimed at elucidating the nature of the association between disgust experienced during traumatic events and subsequent psychopathology.

Alcohol use history and panic-relevant responding among adolescents: a test using a voluntary hyperventilation challenge.

Given the onset of alcohol use, neurological sensitivity, and enhanced panic-relevant vulnerability, adolescence is a key period in which to study the documented linkage between alcohol and panic-related problems. The current study was designed to build upon and uniquely extend extant work via (a) utilization of well-established experimental psychopathology techniques and (b) evaluation of unique associations between alcohol use and panic symptoms after controlling for theoretically relevant behavioral, environmental, and individual difference variables (i.e., age, gender, negative affectivity, anxiety sensitivity, child and parent tobacco use, and parental panic disorder). Participants were 111 community-recruited adolescents ages 12-17 years (M = 15.76 years; n = 50 girls). Youth completed a battery of well-established questionnaires and a voluntary hyperventilation challenge, and parents present at the laboratory completed a structured clinical interview. Adolescent alcohol use was categorized as Non-Users, Experimenters, or Users. Panic symptoms were indexed via retrospective self-report and adolescents' response to a biological challenge procedure (i.e., voluntary hyperventilation). After controlling for theoretically relevant covariates, Users evidenced elevated panic-relevant symptoms and responding compared with Non-Users; Experimenters did not differ from Non-Users. Findings suggest alcohol use history is uniquely associated with panic symptomatology among youth, including "real-time" reactivity elicited by a laboratory challenge. Although there is significant work yet to be done, these data advance extant work and lay the groundwork for the types of sophisticated designs that will be needed to answer the most pressing and complex questions regarding the link between alcohol use and panic symptoms among adolescents.

Biological sex and panic-relevant anxious reactivity to abrupt increases in bodily arousal as a function of biological challenge intensity.

An emerging pattern of results from panic-relevant biological challenge studies suggests women respond with greater subjective anxiety than men, but only to relatively abrupt and intense challenge procedures. The current investigation examined the relation between biological sex and self-reported anxious reactivity following biological challenges of varying durations and intensity. Participants were 285 (152 females; M(age) = 21.38; SD = 5.92) nonclinical adults who completed one of three protocols: a 3-min voluntary hyperventilation challenge (VH), a 5-min 10% carbon dioxide-enriched air (CO(2)) challenge, or a 25-s 20% CO(2) challenge. As predicted, results indicated that the 20% CO(2) challenge elicited greater self-reported anxiety than the VH and 10% CO(2) challenges. Moreover, women endorsed greater anxious reactivity than men, but only following the 20% CO(2) challenge. Results are discussed in terms of processes likely to account for sex differences in anxious reactivity following relatively abrupt and intense biological challenges.

Associations between parental posttraumatic stress disorder and both offspring internalizing problems and parental aggression within the National Comorbidity Survey-Replication.

Data from the National Comorbidity Survey-Replication were used to evaluate links between parental posttraumatic stress disorder (PTSD) and elevated (1) offspring internalizing problems and (2) parental physical aggression toward children. We extended prior tests via the use of an independent nationally representative sample and by examining specific associations between these outcomes and PTSD above and beyond variance accounted for by several theoretically relevant demographic factors and PTSD-related comorbidity. As hypothesized, offspring anxiety and depression was elevated among parents with PTSD compared to those without the condition. Parents with PTSD also were more likely to endorse the use of both moderate (e.g., pushing) and severe (e.g., hitting with a fist) physical aggression with their children. These findings advance work in the area by suggesting that there is a unique relation between PTSD and these outcomes, which sets the stage for research to elucidate factors uniquely introduced by PTSD.

A test of the relations between avoidance of panic-related situations and substance use, substance dependence, and depression among subclinical panickers.

The hypotheses that among subclinical panickers, avoidance of panic-related situations would be associated with elevated substance use levels and increased likelihood of lifetime diagnoses of substance dependence and major depressive disorder (MDD) were tested. Findings confirmed that panic-related avoidance was associated with an elevated likelihood of lifetime diagnoses of nicotine and alcohol dependence as well as MDD, but not drug dependence. Panic avoidance was also related to relatively greater daily levels of cigarette and alcohol use.

Interactive roles of pubertal timing and peer relations in predicting social anxiety symptoms among youth.

The interaction between early maturation and problematic peer relations in relation to social anxiety symptoms was examined among 167 adolescents aged 10-17 years. Results indicated that early-maturing youth with problematic peer relations evidenced elevated social anxiety symptoms. Findings are discussed in terms of theoretical implications for adolescent social anxiety development.

Parenting-related childhood learning history and panic vulnerability: a test using a laboratory-based biological challenge procedure.

A small but growing literature highlights specific parenting behaviors in increasing panic vulnerability among offspring. The current study examined the association between parenting-related instrumental and observational learning of sick-role behavior during childhood and reactivity to a panic-relevant biological challenge procedure that has evidenced predictive validity in terms of panic onset. Participants were 93 physically and psychologically healthy young adults (39 females; M(age)=23.41 years). As expected, results indicated that instrumental learning experiences involving (panic-relevant) arousal-reactive symptoms predicted increased post-challenge anxiety, arousal, and negative affective valence, even after accounting for variability associated with other theoretically relevant variables (e.g., anxiety sensitivity). Consistent with prior work, this learning history effect was specific to arousal-reactive, as opposed to arousal non-reactive, symptoms. Unexpectedly, observational learning was not related to challenge responding. Findings are discussed in terms of the potential role of parenting in etiologic models of panic development.

Evaluating the role of contingency in differentially reinforced tic suppression.

The current study evaluated the effects of tokens delivered on differential reinforcement of zero-rate behavior (DRO) schedules or noncontingently on tic suppression in 4 children with tics. Tic frequency was lower in 3 of 4 children when tokens were delivered contingent on the absence of tics than when tokens were delivered noncontingently.

Establishing the feasibility of direct observation in the assessment of tics in children with chronic tic disorders.

Behavior analysis has been at the forefront in establishing effective treatments for children and adults with chronic tic disorders. As is customary in behavior analysis, the efficacy of these treatments has been established using direct-observation assessment methods. Although behavior-analytic treatments have enjoyed acceptance and integration into mainstream health care practices for tic disorders (e.g., psychiatry and neurology), the use of direct observation as a primary assessment tool has been neglected in favor of less objective methods. Hesitation to use direct observation appears to stem largely from concerns about the generalizability of clinic observations to other settings (e.g., home) and a lack of consensus regarding the most appropriate and feasible techniques for conducting and scoring direct observation. The purpose of the current study was to evaluate and establish a reliable, valid, and feasible direct-observation protocol capable of being transported to research and clinical settings. A total of 43 children with tic disorders, collected from two outpatient specialty clinics, were assessed using direct (videotape samples) and indirect (Yale Global Tic Severity Scale; YGTSS) methods. Videotaped observation samples were collected across 3 consecutive weeks and two different settings (clinic and home), were scored using both exact frequency counts and partial-interval coding, and were compared to data from a common indirect measure of tic severity (the YGTSS). In addition, various lengths of videotaped segments were scored to determine the optimal observation length. Results show that (a) clinic-based observations correspond well to home-based observations, (b) brief direct-observation segments scored with time-sampling methods reliably quantified tics, and (c) indirect methods did not consistently correspond with the direct methods.