Examining The Relationships Between Posttraumatic Stress Disorder Symptoms, Positive Smoking Outcome Expectancies, And Cigarette Smoking In People With Substance Use Disorders: A Multiple Mediator Model
abuse treatment; anxiety disorders; Cigarette smoking; consequences questionnaire; daily smokers; fagerstrom test; negative affect; nicotine dependence; Positive smoking outcome expectancies; posttraumatic stress disorder (PTSD); psychiatric-disorders; Psychology; scale ces-d; Substance Abuse; Substance use disorder (SUD); tobacco use
Cigarette smoking is highly prevalent in people with substance use disorders (SUDs) and is associated with significant physical health problems. Posttraumatic stress disorder (PTSD) is also highly associated with both SUDs and cigarette smoking and may serve as a barrier to smoking cessation efforts. In addition, people with PTSD are more likely to hold positive smoking outcome expectancies (i.e., beliefs that smoking cigarettes results in positive outcomes); these beliefs may contribute to cigarette smoking in people with SUDs experiencing PTSD symptoms. The present study examined the relationship between PTSD symptoms and typical daily cigarette smoking/cigarette dependence symptoms in a sample of 227 trauma-exposed current smokers with SUDs (59.9% male, 89.4% Caucasian) seeking detoxification treatment services. Additionally, the indirect effects of multiple types of positive smoking outcome expectancies on these relationships were examined. Participants completed questionnaires assessing PTSD symptoms, positive smoking outcome expectancies, cigarette consumption, and cigarette dependence symptoms. Results indicated that PTSD symptoms were not directly related to cigarette consumption or cigarette dependence symptoms. However, negative affect reduction outcome expectancies were shown to have a significant indirect effect between PTSD symptoms and cigarette consumption, while negative affect reduction, boredom reduction, and taste-sensorimotor manipulation outcome expectancies were all found to have significant indirect effects between PTSD symptoms and cigarette dependence symptoms. The indirect effect involving negative affect reduction outcome expectancies was statistically larger than that of taste sensorimotor manipulation outcome expectancies, while negative affect reduction and boredom reduction outcome expectancies were comparable in magnitude. These results suggest that expectancies that smoking can manage negative affective experiences are related to cigarette smoking in people with SUDs experiencing PTSD symptoms and suggest that effective smoking cessation treatments should take into account these expectancies. (C) 2013 Elsevier Ltd. All rights reserved.
Hruska B; Bernier J; Kenner F; Kenne D R; Boros A P; Richardson C J; Delahanty D L
Addictive Behaviors
2014
2014-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.addbeh.2013.10.002" target="_blank" rel="noreferrer noopener">10.1016/j.addbeh.2013.10.002</a>
The Role of Negative Affect on Headache-Related Disability Following Traumatic Physical Injury.
Acute Disease – Etiology; ACUTE diseases; acute physical injury; Adult; Anxiety Disorders; ANXIETY disorders; Arousal; AROUSAL (Physiology); avoidance; Avoidance (Psychology); AVOIDANCE (Psychology); Chronic Pain; CHRONIC pain; Depression; Early Intervention; EARLY medical intervention; HEADACHE; Headache – Etiology; headache-related disability; Health Status; HEALTH status indicators; Human; hyperarousal; INJURY complications; Linear Regression; LONGITUDINAL method; MENTAL depression; negative affect; Nonexperimental Studies; OBSERVATION (Scientific method); Post-Traumatic; POST-traumatic stress disorder; Prospective Studies; PTSD symptoms; REGRESSION analysis; Secondary Analysis; SECONDARY analysis; Stress Disorders; Trauma – Complications
OBJECTIVE: Acute postinjury negative affect (NA) may contribute to headache pain following physical injury. Early psychiatric-headache comorbidity conveys increased vulnerability to chronic headache-related disability and impairment. Yet, it is unknown whether NA is involved in the transition to chronic headache related-disability after injury. This prospective observational study examined the role of acute postinjury NA on subacute and chronic headache-related disability above and beyond nonpsychiatric factors. METHODS: Eighty adult survivors of single-incident traumatic physical injury were assessed for negative affect (NA): a composite of depression and anxiety symptoms, and symptoms of posttraumatic stress disorder (PTSS) during the acute 2-week postinjury phase. NA was examined as the primary predictor of subacute (6-week) and chronic (3-month) headache-related disability; secondary analyses examined whether the individual NA components differentially impacted the outcomes. RESULTS: Hierarchical linear regression confirmed NA as a unique predictor of subacute (Cohen's f (2) = 0.130; P = .005) and chronic headache related-disability (Cohen's f (2) = 0.160; P = .004) beyond demographic and injury-related factors (sex, prior headaches, and closed head injury). Upon further analysis, PTSS uniquely predicted greater subacute (Cohen's f (2) = 0.105; P = .012) and chronic headache-related disability (Cohen's f (2) = 0.103; P = .022) above and beyond demographic and injury-related factors, depression, and anxiety. Avoidance was a robust predictor of subacute headache impairment (explaining 15% of the variance) and hyperarousal was a robust predictor of chronic headache impairment (10% of the variance). CONCLUSION: Although NA consistently predicted headache-related disability, PTSS alone was a unique predictor above and beyond nonpsychiatric factors, depression, and anxiety. These results are suggestive that early treatment of acute postinjury PTSS may correlate with reductions in disability and negative physical health sequelae associated with PTSS and chronic headache.
Pacella Maria L; Hruska Bryce; George Richard L; Delahanty Douglas L
Headache
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/head.13233" target="_blank" rel="noreferrer noopener">10.1111/head.13233</a>
When Exposures Go Right: Effective Exposure-based Treatment For Obsessive-compulsive Disorder
alliance; anxiety disorders; Clinical recommendations; cognitive-behavior therapy; Evidence-based treatment; Exposure-based therapy; fear; metaanalysis; OCD; OCD; prevention; Psychology; Psychology; Psychotherapy; youth
Cognitive behavioral therapy with exposure and response prevention (CBT-E/RP) is the first-line treatment for obsessive-compulsive disorder (OCD). Several CBT-E/RP treatment manuals exist, yet clinicians still struggle to implement this evidence-based form of therapy. This article aims to help clinicians implement exposure-based treatment for OCD by providing practical treatment-enhancing strategies. In particular, literature and treatment recommendations related to effective hierarchy formation, strategic exposure design, and optimal exposure implementation is reviewed. Clinical case examples are provided throughout the paper to illustrate important principles, concepts, and recommendations. This paper aims to enhance the delivery of CBT-E/RP and address common questions and concerns that both new and advanced clinicians encounter when learning and applying this form of psychotherapy. Improving the integrity of CBT-E/RP delivery can improve therapeutic outcomes, patient compliance, and successful treatment completion.
Jordan C; Reid A M; Guzick A G; Simmons J; Sulkowski M L
Journal of Contemporary Psychotherapy
2017
2017-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1007/s10879-016-9339-2" target="_blank" rel="noreferrer noopener">10.1007/s10879-016-9339-2</a>