Joseph W. Boffa

• Doctor of Psychology
• Core Investigator and Suicide Prevention Coordinator at Southeast Louisiana Veterans Health Care System

Objective: Suicide is a major public health concern and the third leading cause of death for people aged 15–24. In recent years, suicidal ideation and behaviors among university students have increased. Posttraumatic stress disorder (PTSD) is a well-established factor related to suicidal ideation, behaviors, and risk across populations. It is impor...

Insomnia, characterized by difficulty initiating or maintaining sleep, is a robust transdiagnostic correlate of suicidal ideation (SI). Nevertheless, there remains a lack of research exploring factors that may account for this association. One approach to advancing our understanding of these associations, is to draw from theoretical models of suici...

Written exposure therapy (WET) is a brief, manualized trauma‐focused treatment typically delivered in five individual weekly sessions. Given the brevity and effectiveness of WET, researchers have begun to focus on its delivery in a massed format. However, only one case study examining massed delivery has been published to date. As such, the objecti...

Purpose The purpose of the current study was to conduct a comprehensive meta-analytic review of Cognitive Processing Therapy (CPT) for PTSD among military personnel and veterans. Additionally, we sought to examine potential moderators of treatment outcomes including type of comparison condition (e.g., active trauma-focused, active non-trauma-focuse...

Objective: Although not all trauma-exposed individuals develop posttraumatic stress disorder (PTSD) symptoms or nonsuicidal self-injury (NSSI), it has been suggested that those who use NSSI as a means of coping with PTSD symptoms increase their acquired capability for suicide. This study sought to test the relationship between PTSD symptom clusters...

Objective: Emerging evidence indicates that a nontrivial proportion of suicide attempt (SA) survivors develop clinically significant posttraumatic stress disorder (PTSD) symptoms related to their suicide attempt (SA-PTSD). However, SA-PTSD is rarely assessed in either clinical practice or research studies, due at least in part to a lack of research...

Background Research has suggested that some individuals report posttraumatic stress disorder (PTSD) symptoms following a suicide attempt (SA). However, there is debate as to whether one’s own SA should be recognized as a criterion event for PTSD symptoms. Alternatively, trauma research has identified moral injury as a consequence of trauma that is...

We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater...

Background Despite interest in psychological inflexibility as a marker of suicide risk, no measure of psychological inflexibility specific to SI exists. Methods The present study utilized data from two internet- and one lab-based sample to establish and evaluate such a measure, the Acceptance and Action Questionnaire for Suicidal Ideation (AAQ-SI)...

Suicide is a growing public health concern, particularly among veterans. Notably, veterans who report experiencing a military sexual trauma (MST) are at even greater risk for suicide compared to those who do not. Research has implicated distress intolerance (DI), the perceived inability to withstand aversive emotional and somatic states, as an impo...

Suicide rates among veterans are routinely higher than among civilians. Notably, rural veterans appear to be at an even greater risk than urban veterans. Though researchers have endeavored to understand veteran suicide through the lens of the interpersonal theory of suicide (IPTS), none have done so with rural samples. This study evaluated the cont...

The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on the world. In the United States, healthcare systems have been taxed, medical supplies depleted, and healthcare providers overburdened by the increased need. Although psychologists cannot provide medical services, we possess a unique skillset that can alleviate some of the st...

Despite a growing body of research examining correlates and consequences of COVID-19, few findings have been published among military veterans. This limitation is particularly concerning as preliminary data indicate that veterans may experience a higher rate of mortality compared to their civilian counterparts. One factor that may contribute to inc...

The association between posttraumatic stress disorder (PTSD) and suicidal ideation is well-established and recent prospective studies have demonstrated the unique role of hyperarousal symptoms. In particular, over-arousal may elevate suicide risk in the presence of interpersonal vulnerability factors including thwarted belongingness, perceived burd...

Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors' experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and syn...

Objective: Posttraumatic stress disorder (PTSD) is a prevalent and impairing condition that often involves difficulties with interpersonal functioning. Targeting interpersonal difficulties may be a promising alternative approach to reducing PTSD symptoms, particularly given the relatively low rates of treatment engagement and efficacy for first-li...

Insomnia symptoms prior to traumatic event exposure predict the development of post‐traumatic stress symptoms. However, potential mechanisms underlying the association between insomnia and risk for post‐traumatic stress disorder symptoms have not been prospectively tested. The current study used the trauma film paradigm to test whether insomnia sym...

Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factor...

Objectives: Suicide attempts (SAs), by definition, represent a risk for serious injury or death; thus, one's SA may contribute to the development of posttraumatic stress disorder (PTSD). Yet, empirical data on this topic are lacking. This study aimed to characterize the phenomenology, rate, and associated features of PTSD following one's SA. Meth...

Objective Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk among firefighters. Few studies have examined modifiable factors, such as mindfulness facets, that might attenuate this association. This study examined the interactive effects of PTSD symptoms and mindfulness facets in relation to suicide risk among...

Identifying a malleable pre-trauma risk marker for posttraumatic stress is crucial to preventing symptom development among at-risk individuals. One such candidate is anxiety sensitivity cognitive concerns (ASCC), which represents the fear of psychological incapacitation due to anxious arousal. While the extant literature suggests that applying ASCC...

Objective: Suicide is a global public health concern. To inform the prevention and treatment of suicidality, it is crucial to identify transdiagnostic vulnerability factors for suicide and suicide-related conditions. One candidate factor is anxiety sensitivity (AS)-the fear of anxiety-related sensations-which has been implicated in the pathogenesi...

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...

Objective: A suicide attempt is at least somewhat life-threatening by definition and is, for some, traumatic. Thus, it is possible that some individuals may develop posttraumatic stress disorder (PTSD) from a suicide attempt. Method: In this article, we consider whether one's suicide attempt could fulfill Diagnostic and Statistical Manual of Men...

Traumatic brain injury is prevalent and linked with heightened risk for post-traumatic stress symptoms, yet little research has investigated the role of well-established cognitive-affective risk factors in explaining this association. The present study addressed this gap by evaluating if elevations in anxiety sensitivity global score and subscales...

Past research indicates that firefighters are at increased risk for suicide. Firefighter-specific occupational stress may contribute to elevated suicidality. Among a large sample of firefighters, this study examined if occupational stress is associated with multiple indicators of suicide risk, and whether distress tolerance, the perceived and/or ac...

Low distress tolerance, the perceived or actual inability to tolerate negative emotional states, is a transdiagnostic risk marker associated with greater PTSD symptoms and poorer treatment outcomes. However, the role of distress tolerance in PTSD symptom trajectories has not yet been explored. This study examined the mediating role of distress tole...

Background: Firefighters represent an occupational group at increased suicide risk. How suicidality develops among firefighters is poorly understood. The depression-distress amplification model posits that the effects of depression symptoms on suicide risk will be intensified in the context of anxiety sensitivity (AS) cognitive concerns. The curre...

Background: Interventions aimed at preventing suicidal thoughts target people at risk for suicide based on risk factor elevations. Based on the interpersonal psychological theory of suicide, elevated perceived burdensomeness (PB) and thwarted belongingness (TB) are potential targets for prevention of the occurrence of suicidal thoughts. PB is the...

Posttraumatic stress disorder (PTSD) symptoms are positively related to suicide risk among firefighters. One mechanism that may account for this relationship is anxiety sensitivity (AS) cognitive concerns-the fear that cognitive symptoms of anxiety will have catastrophic consequences. We sought to replicate the mediating effect of AS cognitive conc...

Background Although a burgeoning line of research identifies emotion regulation difficulties as a potential maintenance factor for posttraumatic stress disorder (PTSD), little is known in regard to what emotion regulation strategies individuals with PTSD use in their daily lives, their predictors, and their consequences on later PTSD symptoms. Meth...

Insomnia disorder is impairing and prevalent, particularly among individuals with comorbid anxiety disorders. Despite the availability of effective computerized treatments for insomnia, there are few that target both insomnia as well as co-occurring anxiety symptoms. The current study tests the efficacy of a computerized treatment for anxiety sensi...

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...

Traumatic brain injury (TBI) is both prevalent and potentially disabling. Extant literature has demonstrated women to report greater post-concussive symptoms (PCS) compared to men, highlighting the necessity of investigations into malleable, gender-linked risk factors for PCS that hold promise for reducing this gender disparity. Anxiety Sensitivity...

Firefighters are at increased risk for mental health problems. However, little is known about differences in psychiatric symptoms between volunteer and career firefighters. This study aimed to (1) describe differences in psychiatric symptoms and barriers to mental health care between U.S. firefighters in volunteer-only and career-only departments;...

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)...

Females are two times as likely as males to develop generalized anxiety disorder (GAD; Steiner et al., 2005; Vesga-López et al., 2008). Moreover, the clinical presentation of GAD is different across genders. One explanation for these differences may be the role of cognitive biases involved in GAD between genders. In the present study, we used an ex...

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...

Intolerance of uncertainty (IU) has been associated with elevated post-traumatic stress symptoms (PTSS) in the extant literature. However, no research to date has investigated whether pre-trauma IU predicts PTSS following trauma exposure. The current study prospectively examined the relationship between IU and PTSS within a sample of individuals wi...

Objective: The misuse of alcohol is related to numerous detrimental health effects. Research has determined anxiety sensitivity (AS) to be a risk factor for problematic alcohol use. To date, no studies have investigated this relationship using a bifactor model of AS. This study used a bifactor model to determine the effects of the general AS facto...

Growing interest in developing more effective smoking cessation treatments has facilitated the need to further investigate cognitive-affective factors that inhibit successful smoking cessation, such as urges to smoke. Research has strongly supported an association between suicidality and smoking, yet no work has investigated whether suicidality may...

Although posttraumatic stress disorder (PTSD) is associated with self-injurious behavior, it is currently unclear what mechanisms may account for this relationship. Sleep disturbances may be relevant as they are common among those with PTSD and are associated with emotion regulation difficulties, which may increase vulnerability to self-injurious b...

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...

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...

Hoarding disorder is characterized by persistent difficulty discarding possessions resulting in clutter that precludes one from using living areas for their intended purposes. The limited empirical work available has suggested a strong link between hoarding and various non-psychiatric conditions, including obesity. Despite these associations, no re...

Attention bias modification (ABM) may be an effective treatment for anxiety disorders (Beard, Sawyer, & Hofmann, 2012). As individuals with PTSD possess an attentional bias towards threat-relevant information ABM may prove effective in reducing PTSD symptoms. We examined the efficacy of ABM as an adjunct treatment for PTSD in a real-world setting....