Aaron Norr

• Ph.D.
• Professor (Assistant) at University of Washington

Introduction Suicide rates in the military are a significant public health concern. The suicide prevention safety planning intervention is a brief and effective intervention in which a provider and patient work collaboratively to recognize warning signs of a suicidal crisis and create a defined list of coping strategies and supports for use during...

The aim of this study was to explore the impact of baseline learner characteristics on motivational interviewing (MI) skill acquisition with and without virtual standardized patient (VSP) supplementation. Data from a two-group, randomized trial of 120 volunteer health care professionals recruited from a Department of Veterans Affairs and Department...

Prolonged exposure (PE) Coach is a mobile application designed to support the tasks of PE psychotherapy for posttraumatic stress disorder (PTSD). However, little is known about patient treatment preferences for the application nor its impact on clinically salient outcomes. Veterans with PTSD (N = 20) were randomly assigned to use PE Coach during th...

Background: Little is known about the impact of mobile applications (apps) designed to support patients progressing through an evidence-based psychotherapy. Prolonged exposure (PE) is an efficacious treatment for posttraumatic stress disorder (PTSD) and PE Coach is a treatment companion app that may increase patient engagement with the active comp...

Access to mental health services, particularly for veterans residing in underserved communities, remain scarce. One approach to addressing availability barriers is through the use of group-based transdiagnostic or unified treatment protocols. One such protocol, Safety Aid Reduction Treatment (START), previously termed False Safety Behavior Eliminat...

Anxiety sensitivity (AS) and AS subfactors (physical, cognitive, and social) have been found to have robust associations with suicide risk. While the direct association between AS subfactors and suicide risk have been explored, little is known about how specific mechanisms, such as dissociation, might explain this relationship. This study aimed to...

Purpose of Review The training of psychiatrists and other mental health professionals requires education on a range of interpersonal, communication, and psychotherapy techniques. Classroom and workshop training must be augmented by experiential learning with feedback for skill implementation with fidelity. Virtual standardized patients (VSPs) are c...

Given the substantial investment in the development of mental health mobile applications (apps), information about penetration in the patient populations of interest is critical. This study describes the proportion of veterans who are knowledgeable of and utilize the Department of Veteran Affairs (VA) and Department of Defense (DoD) mental health a...

It is estimated that individuals with severe health anxiety (HA) utilize 41%-78% more healthcare resources than individuals with identified medical diagnoses. Thus, identifying targets for intervention and prevention efforts for HA that are appropriate for primary care or specialty clinic settings is imperative. The aim of the present investigation...

Background: This investigation involved an in‐depth examination of psychophysiological responses during exposure to the trauma memory across 10 sessions among active duty soldiers with combat‐related posttraumatic stress disorder (PTSD) treated by Prolonged Exposure (PE) or Virtual Reality Exposure (VRE). We compared psychophysiological changes, se...

Posttraumatic stress disorder (PTSD) is linked to both altered physiological functioning and poorer cardiovascular health outcomes, including an increased risk for cardiovascular disease and cardiovascular‐related mortality. An important question is whether interventions for PTSD might ameliorate the risk for poorer health by improving cardiovascul...

Importance Despite the need for effective and scalable training in motivational interviewing (MI) that includes posttraining coaching and feedback, limited evidence exists regarding the effectiveness of using virtual (computerized) standardized patients (VSPs) in such training. Objective To evaluate the efficacy of training with a VSP on the acqui...

The emotional processing theory of posttraumatic stress disorder (PTSD) posits that avoidance is central to PTSD development and maintenance. Prolonged exposure (PE) therapy, which clinically focuses on avoidance reduction, has strong empirical support as a PTSD treatment. Virtual reality exposure (VRE) has been utilized to accelerate avoidance red...

Background/Objectives One-half of all U.S. adults will experience at least one traumatic event, and of those, approximately 11% develop posttraumatic stress disorder (PTSD) symptoms. Despite efficacious treatments for PTSD, one-third of people diagnosed still express symptoms after treatment.Thus, it is important to identify underlying factors that...

People in need of mental health treatment do not access care at high rates or in a timely manner, inclusive of Veterans at Department of Veteran's Affairs (VA) medical centers. Barriers to care have been identified, and one potential solution is the use of technology-based interventions within primary care. This study evaluated the Cognitive Anxiet...

Although cognitive behavioral interventions improve attitudes toward mental health treatment and reduce stigma, little is known about which types of attitudes change, or how this change occurs. Active duty soldiers with PTSD (N = 162) were randomized to 10 sessions of exposure therapy or a waitlist. Soldiers were assessed for PTSD and completed mea...

Objective: A key symptom of posttraumatic stress disorder (PTSD) is hyperreactivity to trauma-relevant stimuli. Though physiological arousal is reliably elevated in PTSD, the question remains whether this arousal responds to treatment. Virtual reality (VR) has been posited to increase emotional engagement during prolonged exposure therapy (PE) for...

Objective: Posttraumatic stress disorder (PTSD) is linked to poor health, including cardiovascular disease (CVD). These effects may be a result of increased tonic cardiovascular function and cardiovascular reactivity (CVR). Despite PTSD's negative health burden, relatively little is known about whether frontline treatments for PTSD may alleviate c...

Background: Posttraumatic stress disorder (PTSD) results in high costs to society, particularly among military personnel. Much is known about PTSD treatments-such as exposure therapies-and their outcomes, but less is known about how treatment might impact social support and PTSD symptoms over the course of treatment. Methods: In the current stud...

Active duty military service members have high dropout rates for trauma-focused treatment in both clinical practice and research settings. Measuring patients' intent to complete (ITC) and intent to attend (ITA) treatment have been suggested as methods to reduce dropout, but no studies have examined the effectiveness of such measures. In an attempt...

Objective: The current study sought to examine the relationship between changes in distress for items on in-vivo exposure hierarchies and posttraumatic stress disorder (PTSD) symptom change over the course of exposure therapy. Methods: Active duty army soldiers (N = 108) were recruited from a military base in the U.S. and were enrolled in a rand...

Research has described the association between lifetime trauma exposure and psychiatric symptoms among various cohorts, but little is known about the effect of lifetime trauma histories on the symptom expression of active-duty military personnel diagnosed with combat-related posttraumatic stress disorder (PTSD). Active-duty soldiers (N = 162) were...

While psychotic-like experiences (PLEs), including persecutory ideation and auditory or visual hallucinations, are common in PTSD, questions remain about their relationships to core PTSD symptoms and responsiveness to treatment. This study examined data from a waitlist (WL) controlled clinical study of the effect of virtual reality (VR) and prolong...

Purpose: Measurement of simulator-related side effects (SSEs) is an integral component of competent and ethical use of virtual reality exposure (VRE), but common SSEs may overlap with symptoms of anxiety. Limited research exists about the frequency of SSEs during VRE treatment for post-traumatic stress disorder (PTSD) and no research compares self...

Cognitive models of posttraumatic stress disorder (PTSD) implicate interpretation biases as a maintaining factor of symptoms. Existing measures index symptoms and negative beliefs in PTSD patients, but not threatening interpretation of socially-ambiguous information, which would further inform cognitive models of PTSD. Here we describe the developm...

Prolonged exposure (PE) is a treatment for posttraumatic stress disorder (PTSD) based on emotional processing theory. According to this theory, emotional engagement during imaginal exposure is critical to clinical outcome. One rationale for virtual reality exposure therapy (VRE) is the ability of trauma-relevant, multi-sensory stimuli to increase e...

1 Background The majority of studies comparing active psychological treatments for posttraumatic stress disorder (PTSD) do not find significant differences at posttreatment. This was the case in a recent trial examining prolonged exposure (PE) and virtual reality exposure (VRE) among active‐duty soldiers with combat‐related PTSD. Matching individua...

This article provides an overview of F-SET, a brief transdiagnostic treatment for anxiety disorders. The article focuses on the use of specific treatment techniques and follows a successful course of treatment using the F-SET protocol. The client's treatment progress is discussed session by session and at midtreatment, posttreatment, and 11-month f...

Objective: The current study sought to investigate the effects of exposure therapy on suicidal ideation (SI), as well as potential mechanistic pathways of SI reduction among active duty military personnel. Methods: Active duty army soldiers (N = 162) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial...

Objective: High anxiety sensitivity (AS) and poor attention control (AC) are established risk factors for posttraumatic stress symptoms (PTSS), but little is known about the combined influence of these variables. Consistent with dual-systems models suggesting facets of executive function (e.g., AC) will modulate the effects of other risk factors (...

Background: The suicide rate in the Unites States continues to increase suggesting novel intervention strategies are needed. Anxiety sensitivity (AS), or a fear of anxiety-related sensations, is a suicide risk factor that can be ameliorated via a single-session, computerized intervention called the Cognitive Anxiety Sensitivity Treatment (CAST). R...

Cyberchondria refers to a clinical phenomenon in which repeated Internet searches regarding medical information result in excessive concerns about physical health. Cyberchondria is positively associated with symptoms of health anxiety, though it remains unclear as to whether cyberchondria poses a unique public burden. The current study replicated p...

Purpose of review: This review provides an overview of the current evidence base for and clinical applications of the use of virtual reality (VR) in psychiatric practice, in context of recent technological developments. Recent findings: The use of VR in psychiatric practice shows promise with much of the research demonstrating clinical effective...

Technology-based interventions have the potential to drastically increase the reach of efficacious treatments for psychiatric disorders by overcoming common barriers to treatment such as cost, accessibility, and convenience. One such treatment, the Cognitive Anxiety Sensitivity Treatment (CAST), has demonstrated efficacy in the treatment of anxiety...

A growing body of research suggests the importance of anxiety sensitivity (AS) in the development and maintenance of posttraumatic stress symptoms (PTSS). Specifically, AS cognitive concerns (fears of cognitive dyscontrol) may be particularly relevant for those with elevated PTSS. Preliminary research has suggested that interventions targeting AS m...

Background: Anxiety sensitivity cognitive concerns (ASCC), refer to fears of mental catastrophe or losing control over mental processes. Recent findings show that ASCC are related to suicide risk, mood disorders and trauma-related disorders. Using controlled experimental psychopathology paradigms could be one heretofore unutilized method of increa...

Objective: Anxiety sensitivity (AS) is a well-established transdiagnostic risk factor for anxiety and mood psychopathology including suicide. A variety of interventions using cognitive-behavioral skills as well as cognitive bias modification (CBM) suggest that AS can be quickly and effectively reduced in nonclinical and nontreatment seeking sample...

Background: Anxiety sensitivity (AS), or a fear of anxiety-related sensations, has become one of the most well researched risk factors for the development of psychopathology and comprises three subfactors: physical, cognitive, and social concerns. Fortunately, research has demonstrated brief protocols can successfully reduce AS, and in turn improv...

Prior research has shown that difficulties in emotion regulation is associated with overall levels of posttraumatic stress symptoms (PTSS). However, it is currently unclear which facets of difficulties in emotion regulation (e.g., lack of emotion regulation strategies, impulse control problems, non-acceptance of emotional responses) are associated...

Objective: Anxiety disorders contribute substantially to the overall public health burden. Anxiety sensitivity (AS), a fear of anxiety-related sensations, is one of the few known malleable risk factors for anxiety pathology. Previous AS reduction treatments have primarily utilized "top-down" (e.g., psychoeducation) interventions. The goal of the c...

Despite the well-documented efficacy of cognitive behavioral treatments for anxiety disorders, the acceptability of these treatments remains an under-researched area. A better understanding of acceptability could help to improve the initiation of, and engagement in, these effective interventions. Recent research has suggested computerized intervent...

Research into the causes and prevention of suicide has been deemed a national priority, with a recent focus on sectors of the workforce, such as firefighters, who experience occupational hazards that may confer risk for suicide. Elevated levels of posttraumatic stress symptoms (PTSS), which show robust relationships with both suicidal ideation (SI)...

Anxiety sensitivity (AS), the feared consequences of anxious arousal, is known to be related to posttraumatic stress symptoms (PTSS) concurrently and longitudinally. However, no studies have demonstrated whether AS prior to a Criterion A traumatic event predict later PTSS. The present study evaluated whether pre-shooting AS predicted PTSS following...

Despite well-established gender differences in the rates of Posttraumatic Stress Disorder (PTSD), there is a lack of research examining malleable, gender-linked risk factors that could be targeted in interventions to reduce risk among women. One such risk factor is anxiety sensitivity (AS), or a fear of anxiety related sensations. AS is elevated in...

Suicide constitutes a significant public health burden as global suicide rates continue to increase. Thus, it is crucial to identify malleable suicide risk factors to develop prevention protocols. Anxiety sensitivity, or a fear of anxiety-related sensations, is a potential malleable risk factor for the development of suicidal ideation. The Depressi...

Anxiety sensitivity (AS) and emotion regulation (ER) difficulty have been identified as risk factors for anxiety symptoms. Few studies have examined the unique relations between these risk factors and anxiety and even less have examined whether AS and ER difficulty interact in their relations with anxiety. The current study used latent variable mod...

Low levels of risk-taking behavior have been associated with anxiety, but variables that influence risk-averse decision-making are not well-understood. Given that uncertainty is inherent to risk-taking behavior, individual differences in the appraisal of uncertainty (e.g., intolerance of uncertainty (IU)) may affect risk-taking behavior. However, n...

Researchers have recently begun to investigate a vicious cycle of escalating physical health concerns and online medical information seeking coined "cyberchondria". Research has shown that cyberchondria is strongly associated with health anxiety (HA), but there is a dearth of work investigating the potential relationships between cyberchondria and...

Generalized anxiety disorder and obsessive–compulsive disorder are defined by chronic intrusive thoughts. The aim of the present study was to evaluate the relationship between cognitive (attentional control) and motivational (negative urgency) mechanisms potentially underlying worry and obsessions. Participants (N = 526) completed an online questio...

Whereas it has been speculated that the psychopathology risk factors anxiety sensitivity (AS) and distress tolerance (DT) are highly overlapping, no studies have examined whether a core affect sensitivity construct explains this relation. It was hypothesized that, in a sample of 808 treatment-seeking individuals (Mage=35.11, SD=14.94), the best-fit...

Anxiety sensitivity (AS) has recently been linked to suicidality. Specifically, AS cognitive concerns has been implicated as a risk factor, and AS physical concerns as a protective factor, for suicidal ideation and suicide attempts. However, no studies have used structural equation modeling (SEM) to address issues of skewed suicide variables and bi...

Panic attacks (PAs) are highly prevalent among trauma exposed individuals and have been associated with a number of adverse outcomes. Despite high suicide rates among trauma exposed individuals, research to date has not examined the potential relation between panic symptoms and suicidal ideation and behaviors among this high risk population. The cu...

Online medical information seeking has become an increasingly common behavior. Despite the benefits of easily accessible medical information on the Internet, researchers have identified a vicious cycle of increased physical health concerns and online medical information seeking known as "cyberchondria". Despite proposed theoretical models of cyberc...

Anxiety sensitivity (AS), a multidimensional construct, has been implicated in the development and maintenance of anxiety and related disorders. Recent evidence suggests that AS is a dimensional-categorical construct within individuals. Factor mixture modeling was conducted in a sample of 579 adult smokers (M age = 36.87 years, SD = 13.47) to exami...

Anxiety sensitivity and distress tolerance are both hypothesized risk factors for generalized anxiety disorder (GAD) and major depressive disorder (MDD). However, it is unclear whether these factors synergistically influence GAD and MDD and related symptoms. Using latent variable methods, direct and interactive relations between anxiety sensitivity...

AimsTo test whether the relations between anxiety sensitivity (AS), a transdiagnostic risk factor, and alcohol problems are explained by chained mediation models, from AS through anxiety or depressive symptoms then drinking motives in an at-risk sample. It was hypothesized that AS would influence alcohol problems through generalized anxiety or depr...

Anxiety sensitivity (AS) comprises three lower-order dimensions, physical concerns, cognitive concerns, and social concerns, all of which are related to unipolar mood and anxiety disorders (emotional distress disorders). The pattern of these relations suggests that AS cognitive concerns might be best classified as associated with emotional distress...

Increased utilization of online medical information seeking demands investigation of potentially detrimental effects of these activities. The present study investigated whether viewing medical websites may adversely affect anxiety sensitivity (AS), a well-established risk factor for the development of psychopathology. Participants (N = 52) were ran...

Panic can be the result of a malfunctioning “alarm system,” and sometimes manifests as a panic attack. Although panic attacks have been linked to many psychiatric disorders, panic is most closely tied to panic disorder (PD) and agoraphobia (AG). The chapter presents three brief vignettes to illustrate some characteristic features seen in PD and AG....

Research on the mental health effects of quitting smoking is limited. Smokers with mental illness appear to be at a higher risk of unsuccessful smoking cessation. Recent work suggests they are at elevated risk for post-cessation increases in anxiety, depression and suicidal ideation. The current study tested the effects of successful and unsuccessf...

This chapter provides an overview of empirically based treatment approaches to panic disorder, with a specific focus on the use of cognitive behavioral therapy. A detailed literature review focusing on the efficacy and effectiveness of cognitive behavioral therapy for panic disorder is provided. The advantages and disadvantages of combination treat...

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on sui...

Background: Intolerance of uncertainty (IU) is a cognitive vulnerability factor associated with a wide range of anxiety psychopathology. Other cognitive vulnerabilities such as anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI) have also been investigated as constructs of interest across anxiety disorders. As resear...

Recent empirical work has revealed a significant relationship between anxiety sensitivity (AS), particularly the AS cognitive concerns subfactor, and suicidality among cigarette smokers. The current study prospectively tested whether an intervention targeting AS (i.e. an AS-augmented smoking cessation program) would predict lower suicidality in a p...

With the upcoming release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) there has been a necessary critique of the DSM-IV including questions regarding how to best improve the next iteration of the DSM classification system. The aim of this article is to provide commentary on the probable direction the DS...

Despite the high impact of anxiety sensitivity (AS; a fear of anxiety related sensations) research, almost no research attention has been paid to its parent theory, Reiss' expectancy theory (ET). ET has gone largely unexamined to this point, including the prediction that AS is a better predictor of number of fears than current anxiety. To test Reis...

We tested the efficacy of a unified cognitive-behavioral therapy protocol for anxiety disorders. This group treatment protocol, termed false safety behavior elimination therapy (F-SET), is a cognitive-behavioral approach designed for use across various anxiety disorders such as panic disorder (PD), social anxiety disorder (SAD), and generalized anx...

Background: Intolerance of uncertainty (IU) has been identified as a key vulnerability factor among numerous anxiety related conditions. It has been suggested that individuals engage in uncertainty-motivated behaviors such as avoidance, as a way to cope with ambiguous and potentially distressing situations. Patterns of behavioral avoidance have al...