"How am I going to make it through pregnancy?" A qualitative examination of prenatal maternal stress.

BACKGROUND: Prenatal maternal stress (PNMS) is common among childbearing women, and there is substantial evidence that persistent high levels of stress during pregnancy are associated with adverse birth outcomes and poorer postpartum mental health. Therefore, the purpose of this study was to examine the idiographic experiences of women who experienced elevated PNMS during their current or most recent pregnancy. METHODS: Six focus groups were conducted, and data were collected from 26 women (n = 16 pregnant and n = 10 postpartum) at a large medical center in the United States (US). Data from the semi-structured focus group prompts were analyzed by two independent raters using conventional content analysis21 . RESULTS: Three key themes emerged from the data: (1) Navigating Changing Circumstances, (2) Being a "Good" Mother, and (3) Loss of Control and Autonomy. DISCUSSION: The current study offers one of the first in-depth examinations of the experiences of highly stressed pregnant women using a qualitative approach and identifies stressors rarely described in quantitative research. These findings suggest that women's ability to prioritize their self-care, and receive structural/institutional supports in the workplace and instrumental support at home, and overall health literacy promote successful coping with stress and highlight important future directions for intervention.

Elevated risk for obsessive-compulsive symptoms in women pregnant during the COVID-19 pandemic.

The COVID-19 pandemic has led to a public mental health crisis with many people experiencing new or worsening anxiety. Fear of contagion and the lack of predictability/control in daily life increased the risk for problems such as obsessive-compulsive disorder (OCD) in the general population. Pregnant women may be particularly vulnerable to such pandemic-related stressors yet the prevalence of OC symptoms in this population during the pandemic remains unknown. We examined the prevalence of OC symptoms in a sample of 4451 pregnant women in the USA, recruited via targeted online methods at the start of the pandemic. Participants completed self-report measures including the Obsessive-Compulsive Inventory-Revised and the Pandemic-Related Pregnancy Stress Scale. Clinically significant OC symptoms were present in 7.12% of participants, more than twice as high as rates of peripartum OCD reported prior to the pandemic. Younger maternal age, income loss, and suspected SARS-CoV-2 infection were all associated with higher OC symptoms. Two types of pregnancy-specific stress, pandemic-related and pandemic-unrelated, were both associated with higher levels of OC symptoms. Pandemic-related pregnancy stress predicted OC symptoms even after controlling for non-pandemic-related, pregnancy-specific stress. Elevated rates of OC symptoms were observed in women pregnant during the pandemic, particularly those experiencing elevated pandemic-related pregnancy stress. This type of stress confers a distinct risk for OC symptoms above and beyond pregnancy-specific stress and demographic factors. Healthcare providers should be prepared to see and treat more peripartum women with OC symptoms during this and future public health crises.

The disaster worker resiliency training program: a randomized clinical trial.

OBJECTIVES: Disaster workers are at elevated risk for mental health problems as a result of trauma exposures during response efforts. One possible way to prevent mental health problems is to build-up coping resources that promote resilience to the effects of disaster work. The primary aim of this study was to evaluate the efficacy of a resilience building workshop, the Disaster Worker Resiliency Training Program (DWRT), in disaster workers previously exposed to Hurricane Sandy. METHODS: Disaster workers (N = 167) were randomly assigned to the DWRT workshop (n = 78) or a waitlist (n = 89). Workers completed self-report measures on healthy lifestyle behaviors, perceived stress, depression, and Posttraumatic Stress Disorder (PTSD) symptoms at baseline and 3-month follow-up. They also completed a measure assessing subsequent trauma-exposure between the baseline and 3-month post-intervention. RESULTS: Participants in the workshop condition, as compared to those in a waitlist control, reported significantly greater improvements from pre-intervention (T1) to 3-month follow-up (T2) in healthy lifestyle behaviors (η2 = .03; p = .03), stress management (η2 = .03, p = .04), and spiritual growth (η2 = .03, p = .02). Among participants reporting subsequent trauma exposures between T1 and T2  (n = 101), participants in the waitlist condition, were more likely to report significant increases in perceived stress (η2 = .07, p < .01), PTSD (η2 = .05, p = .03), and depression (η2 = .07, p < .01) symptoms. CONCLUSIONS: Participation in the resilience workshop promoted engagement in positive health behaviors and reduced the incidence of mental health symptoms, especially when administered prior to a repeat trauma exposure. Further research is needed to evaluate the long-term health effects of participation in the program.

Trauma-Focused Smoking Cessation for Smokers Exposed to the World Trade Center Disaster: A Randomized Clinical Trial.

INTRODUCTION: The main objective was to evaluate the efficacy of an 8-session, group-based comprehensive smoking cessation and trauma management (CSC-T) treatment among daily smokers (≥5 cigarettes/day) exposed to the World Trade Center (WTC) disaster with elevated WTC-related post-traumatic stress disorder (PTSD) symptoms. METHODS: Participants (N = 90) were randomly assigned to CSC-T (N = 44; 63.6% white; 27.3% female; mean age = 51.32 ± 7.87) or comprehensive smoking cessation (CSC) alone (N = 46; 71.7% white; 28.3% female; mean age = 48.74 ± 10.66), which was comparable in length and time. Assessments included a diagnostic clinical interview and self-report measures of PTSD and respiratory symptoms, and smoking behavior, and biologically confirmed smoking abstinence. Evaluations occurred at a baseline visit, each treatment session, and at 1-, 2-, 4-, 12-, and 26-weeks post-treatment. RESULTS: The two treatments did not differ in regard to PTSD symptom improvement. After quit day (week 6), the two groups had similar 7-day (~15%) and 6-month (~20%) abstinence rates as well as average number of cigarettes smoked, and PTSD and respiratory symptoms. CONCLUSIONS: It is possible that the Cognitive Behavioral Therapy skills specific to quitting smoking, group-based support, and degree of therapist contact, that were available in both treatments may have played a role in equalizing the abstinence rates between the two conditions. Although the current study found no evidence that the CSC-T was superior to the CSC alone treatment, the abstinence rates observed were high relative to previous trials of smokers with diagnosed PTSD. Further development of smoking cessation programs tailored to the needs of smokers with PTSD symptoms continues to be needed. IMPLICATIONS: This study suggests that a CSC program aids in smoking abstinence for smokers with PTSD symptoms and that incorporating trauma management skills, may not add additional benefits for abstinence and PTSD and respiratory symptom relief. Further work is needed to improve smoking cessation efforts for smokers with PTSD symptoms.

Understanding the Connection Between Posttraumatic Stress Symptoms and Respiratory Problems: Contributions of Anxiety Sensitivity.

Respiratory problems and posttraumatic stress disorder (PTSD) are the signature health consequences associated with the September 11, 2001 (9/11), World Trade Center disaster and frequently co-occur. The reasons for this comorbidity, however, remain unknown. Anxiety sensitivity is a transdiagnostic trait that is associated with both PTSD and respiratory symptoms. The present study explored whether anxiety sensitivity could explain the experience of respiratory symptoms in trauma-exposed smokers with PTSD symptoms. Participants (N = 135; Mage = 49.18 years, SD = 10.01) were 9/11-exposed daily smokers. Cross-sectional self-report measures were used to assess PTSD symptoms, anxiety sensitivity, and respiratory symptoms. After controlling for covariates and PTSD symptoms, anxiety sensitivity accounted for significant additional variance in respiratory symptoms (ΔR2 = .04 to .08). This effect was specific to the somatic concerns dimension (ß = .29, p = .020); somatic concerns contributed significantly to accounting for the overlap between PTSD and respiratory symptoms, b = 0.03, 95% CI [0.01, 0.07]. These findings suggest that the somatic dimension of anxiety sensitivity is important in understanding respiratory symptoms in individuals with PTSD symptoms. These findings also suggest that it may be critical to address anxiety sensitivity when treating patients with comorbid respiratory problems and PTSD.

Smoking to Regulate Negative Affect: Disentangling the Relationship Between Posttraumatic Stress and Emotional Disorder Symptoms, Nicotine Dependence, and Cessation-Related Problems.

INTRODUCTION: Posttraumatic stress disorder (PTSD) is associated with various aspects of cigarette smoking, including higher levels of nicotine dependence and cessation difficulties. Affect-regulatory smoking motives are thought to, in part, underlie the association between emotional disorders such as PTSD and smoking maintenance, although few studies have empirically tested this possibility. METHODS: Data were analyzed from 135 treatment-seeking smokers who were directly exposed to the World Trade Center disaster on September 11, 2001. We modeled the direct effect of 9/11 PTSD symptom severity on nicotine dependence, perceived barriers to smoking cessation, and severity of problematic symptoms experienced during prior cessation attempts. We also examined the indirect effect of PTSD on these outcomes via negative affect reduction smoking motives. Parallel models were constructed for additional emotional disorder symptoms, including panic and depressive symptoms. RESULTS: PTSD symptom severity was associated with nicotine dependence and perceived barriers to cessation, but not problems during prior quit attempts indirectly via negative affect reduction smoking motives. Panic and depressive symptoms both had significant indirect effects, via negative affect reduction smoking motives, on all three criterion variables. CONCLUSIONS: Affect-regulatory smoking motives appear to underlie associations between the symptoms of emotional disorders such as PTSD, panic, and depression in terms of smoking dependence and certain cessation-related criterion variables. IMPLICATIONS: Overall, this investigation suggests negative affect reduction smoking motives help to explain the relationship of PTSD, depression, and panic symptoms to nicotine dependence, severity of problems experienced during prior quit attempts and perceived barriers to cessation. These results highlight the importance of assessing motivations for smoking in the context of cessation treatment, especially among those with emotional disorder symptoms. Future interventions might seek to utilize motivational interviewing and cognitive restructuring techniques to address coping-oriented motives for smoking, in addition to skills for managing negative affect, as a means of improving quit outcomes.

The contribution of experiential avoidance and social cognitions in the prediction of social anxiety.

BACKGROUND: Cognitive models propose that social anxiety arises from specific dysfunctional cognitions about the likelihood and severity of embarrassment. Relational frame theory (RFT), on the other hand, posits that social anxiety arises from the unwillingness to endure unpleasant internal experiences (i.e. experiential avoidance [EA]). Although cognitive models have garnered empirical support, it may be that newer models such as RFT can improve our ability to predict and treat social anxiety. AIMS: We aimed to elucidate the relationship between dysfunctional cognitions and EA, as well as their independent and relative contributions to the prediction of social anxiety symptoms. We hypothesized that dysfunctional cognitions and EA would each be associated with social anxiety, as well as with each other. We also predicted that both EA and dysfunctional cognitions would remain independent predictors of social anxiety symptoms after controlling for each other and general distress. METHOD: Undergraduates high (n = 173) and low (n = 233) in social anxiety completed measures of social anxiety, dysfunctional cognitions, EA, and general distress. The overall sample was 66.3% female; mean age = 20.01 years (SD = 2.06). RESULTS: Correlational analyses revealed that EA, dysfunctional cognitions, and social anxiety symptoms were moderately correlated with one another. Additionally, hierarchical regression analyses revealed that dysfunctional cognitions predicted social anxiety symptoms even after controlling for EA; the reverse was not found. CONCLUSIONS: RESULTS suggest that EA and social anxiety specific cognitive distortions overlap to a moderate extent. EA does not add to the prediction of social anxiety symptoms above and beyond dysfunctional cognitions. Additional theoretical and treatment implications of the results are discussed.

Obsessional thoughts and compulsive behaviors in a sample of women with postpartum mood symptoms.

Postpartum psychiatric disorders are widely recognized by clinicians and researchers, yet while much attention has been paid to perinatal mood disorders, considerably less has been given to anxiety and obsessive-compulsive symptoms in this population. The present study examined anxiety and obsessive-compulsive symptoms among postpartum women with mood complaints, with the aim of delineating the relationship between these symptoms. Sixty postpartum women seeking treatment in a perinatal mood disorders clinic completed measures of depression, anxiety, and obsessive-compulsive symptoms. Obsession-like thoughts and compulsive-like ("neutralizing") strategies were present among the majority of the sample, yet the severity of these symptoms ranged widely. Depressive and anxiety symptoms were associated with obsessive and neutralizing compulsive symptoms. It may be helpful to consider anxiety and depressive symptoms as part of a broad spectrum of perinatal psychiatric illness. Clinicians should assess for anxiety and obsessive-compulsive symptoms as routinely as they assess for depressive symptoms in the perinatal period.

The Stony Brook Health Enhancement Program: The development of an active control condition for mind-body interventions.

This article describes the development of a manualized, eight-session multiple health behavior change program which addresses sleep, exercise, nutrition, substance use, and working with one's healthcare team. Our goal was to design a structured, evidence-based program that could be facilitated by a single health professional and could act as an active, credible control for mind-body intervention studies. Psychoeducational content was adapted from the latest government and peer-reviewed guidelines. Preliminary work suggests the program is acceptable and feasible for use in patients of varying ages with heterogeneous mental and physical health problems. It is adaptable for both face-to-face and online delivery.

Clinical and personality traits in emotional disorders: Evidence of a common framework.

Certain clinical traits (e.g., ruminative response style, self-criticism, perfectionism, anxiety sensitivity, fear of negative evaluation, and thought suppression) increase the risk for and chronicity of emotional disorders. Similar to traditional personality traits, they are considered dispositional and typically show high temporal stability. Because the personality and clinical-traits literatures evolved largely independently, connections between them are not fully understood. We sought to map the interface between a widely studied set of clinical and personality traits. Two samples (N = 385 undergraduates; N = 188 psychiatric outpatients) completed measures of personality traits, clinical traits, and an interview-based assessment of emotional-disorder symptoms. First, the joint factor structure of these traits was examined in each sample. Second, structural equation modeling was used to clarify the effects of clinical traits in the prediction of clinical symptoms beyond negative temperament. Third, the incremental validity of clinical traits beyond a more comprehensive set of higher-order and lower-order personality traits was examined using hierarchical regression. Clinical and personality traits were highly correlated and jointly defined a 3-factor structure-Negative Temperament, Positive Temperament, and Disinhibition-in both samples, with all clinical traits loading on the Negative Temperament factor. Clinical traits showed modest but significant incremental validity in explaining symptoms after accounting for personality traits. These data indicate that clinical traits relevant to emotional disorders fit well within the traditional personality framework and offer some unique contributions to the prediction of psychopathology, but it is important to distinguish their effects from negative temperament/neuroticism. (PsycINFO Database Record

Posttraumatic stress symptoms and body mass index among World Trade Center disaster-exposed smokers: A preliminary examination of the role of anxiety sensitivity.

Among individuals exposed to the World Trade Center (WTC) disaster on September 11, 2001, posttraumatic stress disorder (PTSD) and symptoms are both common and associated with increased cigarette smoking and body mass. However, there is little information on the specific processes underlying the relationship of PTSD symptoms with body mass. The current study is an initial exploratory test of anxiety sensitivity, the fear of internal bodily sensations, as a possible mechanism linking PTSD symptom severity and body mass index (BMI). Participants were 147 adult daily smokers (34.0% female) exposed to the WTC disaster (via rescue/recovery work or direct witness). The direct and indirect associations between PTSD symptom severity and BMI via anxiety sensitivity (total score and subscales of physical, cognitive, and social concerns) were examined. PTSD symptom severity was related to BMI indirectly via anxiety sensitivity; this effect was specific to physical concerns about the meaning of bodily sensations. Interventions focusing on anxiety sensitivity reduction (specifically addressing physical concerns about bodily sensations) may be useful in addressing elevated BMI among trauma-exposed persons.

Anxiety sensitivity mediates the association between post-traumatic stress symptom severity and interoceptive threat-related smoking abstinence expectancies among World Trade Center disaster-exposed smokers.

INTRODUCTION: Anxiety sensitivity (fear of internal anxiety-relevant bodily sensations) is an individual difference variable that is associated with the development and maintenance of posttraumatic stress disorder (PTSD) and is also involved in the maintenance/relapse of smoking. Abstinence expectancies are crucial to smoking maintenance, yet, past work has not explored how PTSD symptom severity and anxiety sensitivity contribute to them. METHOD: Participants were 122 treatment-seeking daily smokers (36.1% female; Mage=49.2, SD=9.7; cigarettes per day: M=18.3, SD=15.2) who were exposed to the World Trade Center disaster on September 11, 2001 and responded to an advertisement for a clinical smoking cessation trial. The indirect effect of anxiety sensitivity was tested in terms of the effect of PTSD symptom severity on smoking abstinence expectancies (i.e., anxiety sensitivity as a statistical mediator). RESULTS: PTSD symptom severity was positively associated with interoceptive threat-related smoking abstinence expectancies: expecting harmful consequences (ß=.33, p<.001) and somatic symptoms (ß=.26, p=.007). PTSD symptom severity was also significantly associated with anxiety sensitivity (ß=.27, p=.003). Anxiety sensitivity mediated the association between PTSD symptom severity and expectancies about the harmful consequences (ß=.09, CI95%=.02-.21; ΔR(2)=.076) and somatic symptoms (ß=.11, CI95%=.02-.24; ΔR(2)=.123) from smoking abstinence, with medium effect sizes (Κ(2)=.08 and .10, respectively). CONCLUSIONS: These data document the role of PTSD symptoms in threat-based expectancies about smoking abstinence and suggest anxiety sensitivity may underlie the associations between PTSD symptom severity and abstinence expectancies.

Efficacy of a prevention program for postpartum obsessive-compulsive symptoms.

Obsessive-Compulsive Disorder (OCD) has emerged as a common and impairing postpartum condition. Prospective studies have identified psychological vulnerabilities for the emergence of postpartum obsessive-compulsive symptoms (OCS), including general anxiety symptoms, pre-existing OCS, and specific cognitive distortions. The identification of these factors makes feasible the development of prevention programs that could reduce the impact of postpartum OCS. The present investigation examined a cognitive-behavioral prevention program using a randomized, double blind, controlled trial. Expecting mothers in their 2nd or 3rd trimester with an empirically established, malleable risk factor for postpartum OCS received either the prevention program (N=38) or a credible control program (N=33), both of which were incorporated into traditional childbirth education classes. Results revealed that at 1 month, 3 months, and 6 months postpartum, the prevention program was associated with significantly lower levels of obsessions and compulsions than was the control condition (all p's<0.05). Group differences remained significant even after controlling for baseline OCS and depression symptoms. Those in the prevention condition also reported decreasing levels of cognitive distortions, in contrast to the control condition (p's<0.05). Results support the potential utility of incorporating a CBT-based OCS prevention program into childbirth education classes.