Anxiety Sensitivity, Emotional Avoidance, and PTSD Symptom Severity Among Crack/Cocaine Dependent Patients in Residential Treatment

Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA .
Cognitive Therapy and Research (Impact Factor: 1.7). 06/2012; 36(3):247-257. DOI: 10.1007/s10608-010-9337-8
Source: PubMed


High rates of co-occurring posttraumatic stress disorder (PTSD) have been found among patients receiving treatment for substance use disorders (SUD), and there is evidence that this particular co-occurrence is associated with negative SUD treatment outcomes. Thus, there is utility in establishing the role of psychological vulnerabilities related to PTSD within SUD populations, with the goal of ultimately informing targeted interventions and improving clinical outcomes. Anxiety sensitivity (AS) and emotional avoidance (EA) may be two important factors in this regard, as both have been found to demonstrate associations with posttraumatic stress in other clinical and nonclinical populations. To expand upon this literature, the current study examined the associations between AS and EA and PTSD symptom severity in a sample of traumatic event-exposed crack/cocaine dependent patients in residential SUD treatment (n = 62), as well as the extent to which EA mediated the relation between AS and PTSD symptom severity. As hypothesized, AS and EA were associated with PTSD symptom severity above and beyond the effects of gender and non-specific anxiety symptoms. However, the hypothesis that EA would mediate the relation between AS and PTSD symptom severity was only partially supported. Implications of these findings for understanding and treating co-occurring SUD-PTSD are discussed.

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    • "Similarly, a more recent study found that emotional avoidance and AS were uniquely predictive of PTSD symptom severity in substance-dependent patients even when accounting for anxiety severity and participant sex (Naifeh et al. 2012). When emotional avoidance and AS were considered simultaneously, AS no longer significantly predicted PTSD severity, suggesting that the relationship between AS and PTSD was indirect through emotional avoidance. "
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    ABSTRACT: Individuals with posttraumatic stress disorder (PTSD) exhibit deficits in cognitive and emotional processes. PTSD severity is positively associated with anxiety sensitivity (AS) and difficulties in emotion regulation, and difficulties in emotion regulation mediate the relation between AS and PTSD. However, previous research has not examined the interactive nature of these variables. Associations between PTSD, AS, and difficulties in emotion regulation were examined in patients with PTSD in a residential substance use treatment program (N = 120). Conditional process analyses indicated an interactive effect of difficulties in emotion regulation and AS for predicting PTSD symptom severity. For individuals high in emotion regulation difficulties, PTSD symptom severity was high regardless of level of AS; conversely, for individuals high in AS, increased PTSD severity was observed regardless of level of emotion regulation difficulties. Results suggest directions for future research, including examination of whether targeting patient-specific cognitive-affective processes enhances PTSD treatment response among substance-dependent individuals.
    Cognitive Therapy and Research 04/2015; 39:245-252. DOI:10.1007/s10608-014-9648-2 · 1.70 Impact Factor
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    ABSTRACT: Anxiety sensitivity (AS), defined as the extent to which individuals believe anxiety and anxiety-related sensations have harmful consequences, may play an important explanatory role in the relation between emotional non-acceptance and the expression of traumatic stress symptoms among trauma-exposed smokers. This investigation examined whether lower-order dimensions of AS (cognitive, physical, and social concerns) differentially explain the relation between emotional non-acceptance and post-traumatic stress (PTS) symptom clusters (re-experiencing, avoidance, hyperarousal) among trauma-exposed daily smokers (N = 169, 46% female; Mage = 41, SD = 12.3). AS and its lower-order facets of cognitive and social concerns were found to mediate the relations between emotional non-acceptance and avoidance and hyperarousal PTS symptoms. Using a multiple mediation model, the mediational effect of AS cognitive concerns for the relation between emotional non-acceptance and post-traumatic avoidance symptoms was found to be uniquely evident relative to social and physical concerns. All observed AS effects were evident above and beyond the variance accounted for by gender, number of traumatic event exposure types, negative affectivity, number of cigarettes smoked per day, and alcohol use problems. The present findings suggest cognitive-based AS concerns may play a mechanistic role in the relation between emotional non-acceptance and certain PTS symptoms among trauma-exposed daily smokers.
    Journal of Aggression Maltreatment & Trauma 01/2013; 44(3). DOI:10.1080/16506073.2015.1004191
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    ABSTRACT: Posttraumatic stress disorder (PTSD) co-occurs highly with substance use disorders (SUD), yet the neurobiological basis for this comorbid relationship remains unclear. PTSD and SUDs result in similar pathological states including impulsive behavior, reward deficiency, and heightened stress sensitivity. Hence, PTSD and SUD may depend on overlapping dysfunctional neurocircuitry. Here we provide a short overview of the relationship between comorbid PTSD and SUD, as well as the potential role of select neurotransmitter systems that may underlie enhanced vulnerability to drug abuse in the context of PTSD.
    Pharmacology Biochemistry and Behavior 12/2013; 117. DOI:10.1016/j.pbb.2013.12.001 · 2.78 Impact Factor
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