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The roles of alcohol and alcohol expectancy in the dampening of responses to hyperventilation among high anxiety sensite young adults
Abstract
Previous research suggests that high anxiety sensitivity (AS) young adults are particularly sensitive to alcohol's dampening effects on their responses to arousal-induction challenge [Alcohol.: Clin. Exp. Res. 24 (2000) 1656.]. This sensitivity to alcohol reward may place high AS individuals at increased risk for alcohol abuse. Over-and-above alcohol's pharmacological effects, tension-reduction expectancies might contribute to alcohol's reactivity-dampening effects in high-AS individuals. The present study examined the role of alcohol and alcohol expectancy factors by activating expectancies experimentally. Forty-eight high-AS young adults were randomly assigned to one of three beverage conditions: alcohol (pharmacology plus expectancy), placebo (expectancy only), and control (no pharmacology and no expectancy). Following beverage consumption and absorption, participants underwent a 3-min voluntary hyperventilation challenge. Replicating and extending previous findings, participants in the alcohol condition showed dampened affective and somatic responses to the challenge, and marginally dampened cognitive responses to the challenge, compared to both placebo and control participants. However, placebo participants did not display dampened responses to the challenge relative to control beverage condition participants. Additional analyses suggested that activation of tension-reduction expectancies might have contributed to an “inverse placebo” effect among high-AS participants administered placebo. Implications of the results for future research and for the prevention and treatment of alcohol problems among high-AS individuals are discussed.
... The results revealed that anxiety sensitivity moderates the relationship between trait anxiety and alcohol use and smoking in adolescents (Comeau et al., 2001). Given that people with high anxiety sensitivity are more sensitive to tension-reduction effect, this vulnerability can exacerbate the anxiolytic effects of substance and alcohol in this group of people (MacDonald et al., 2000(MacDonald et al., , 2001, In fact, anxiety sensitivity continues the consumption of substances use by increasing tension-reduction expectancies (MacDonald et al., 2001) and also by moderating the negative reinforcing effect of substance use (reducing anxiety symptoms). ...
... The results revealed that anxiety sensitivity moderates the relationship between trait anxiety and alcohol use and smoking in adolescents (Comeau et al., 2001). Given that people with high anxiety sensitivity are more sensitive to tension-reduction effect, this vulnerability can exacerbate the anxiolytic effects of substance and alcohol in this group of people (MacDonald et al., 2000(MacDonald et al., , 2001, In fact, anxiety sensitivity continues the consumption of substances use by increasing tension-reduction expectancies (MacDonald et al., 2001) and also by moderating the negative reinforcing effect of substance use (reducing anxiety symptoms). ...
Anxiety sensitivity means fear of anxiety-related sensations which is one of the important factors in the development and maintenance of substance-related disorders. Studies support the underlying, mediating, and moderating role of this construct in the etiology of substance related disorders. This review suggests that anxiety sensitivity can play a role in this group of disorders in different ways, such as fear of body sensations, fear of cognitive dyscontrol, and fear of socially observable anxiety symptoms. Finally, high anxiety sensitivity can interfere with the treatment of substance-related disorders as an underlying vulnerability and increase the likelihood of relapse in this group of people.
... However, it is important to note that those studies that investigated self-reported stress reactivity in youth at risk of internalising problems, suggest that heightened stress reactivity to stress-induction paradigms confers risk for substance use, particularly among depression-prone and anxious individuals (e.g. Conrod, Pihl, & Vassileva, 1998;MacDonald, Stewart, Hutson, Rhyno, & Loughlin, 2001). A recent stress challenge study with young adults confirms that there might be two different stress-related pathways to substance misuse: one involving ventral medial reactivity to reward cues (reward sensitivity) and reduce amygdala reactivity to stress and the other involving reduced reward sensitivity and heightened amygdala reactivity to stress (Nikolova, Knodt, Radtke, & Hariri, 2015). ...
... Other studies investigating personality risk factors for anxiety and mood disorders suggest that individuals who score high on measures of anxiety sensi-tivity are particularly sensitive to the fear-reducing effects of alcohol (Conrod et al., 1998;MacDonald et al., 2001;Zack, Poulos, Aramakis, Khamba, & MacLeod, 2007), and other anxiolytic substances, such as benzodiazepines. One process by which substances of abuse, particularly those with sedative/anxiolytic properties, might be particularly attractive for adolescents with internalising psychopathology, anxiety sensitivity, and perceived stress reactivity is by interfering with such individuals' tendencies to selectively process threat cues (Stewart, Westra, Thompson, & Conrad, 2000) and attend to negative self-relevant information (Aramakis, Khamba, MacLeod, Poulos, & Zack, 2012). ...
Background:
Adolescence represents a period of development during which critical biological, as well as social and cognitive, changes occur that are necessary for the transition into adulthood. A number of researchers have suggested that the pattern of normative brain changes that occurs during this period not only predisposes adolescents to engage in risk behaviours, such as experimentation with drugs, but that they additionally make the adolescent brain more vulnerable to the direct pharmacological impact of substances of abuse. The neural circuits that we examine in this review involve cortico-basal-ganglia/limbic networks implicated in the processing of rewards, emotion regulation, and the control of behaviour, emotion and cognition.
Findings and conclusions:
We identify certain neurocognitive and personality/comorbidity-based risk factors for the onset of substance misuse during adolescence, and summarise the evidence suggesting that these risk factors may be further impacted by the direct effect of drugs on the underlying neural circuits implicated in substance misuse vulnerability.
... Three existing data sets that used a long form of the HVQ were combined in developing the HVQ-B. First, MacDonald et al. (2000;MacDonald, Stewart, Hutson, Rhyno, & Lee Loughlin, 2001) used the HVQ in two studies to assess the effects of alcohol on responses to a hyperventilation task in high and low AS participants. For the present study, only the non-alcohol conditions were used (n ¼ 65) to avoid the confounding effects of alcohol on responses to hyperventilation. ...
... For the present study, only the non-alcohol conditions were used (n ¼ 65) to avoid the confounding effects of alcohol on responses to hyperventilation. Undergraduate students were eligible to participate and categorized as high or low AS if they scored 1 SD above or below the mean Anxiety Sensitive Index (Peterson & Reiss, 1992) score for their respective sex (see MacDonald et al., 2000MacDonald et al., , 2001 for additional details on participants and design). Scores assessing participants' reactions during the hyperventilation task were used for the present study. ...
The fear of arousal sensations characterizes some anxiety disorders and is a core feature of an established risk factor for anxiety and related disorders (i.e. anxiety sensitivity; Taylor, 1999). Anxiety sensitivity (AS) refers to a fear of anxiety-related bodily sensations stemming from beliefs that these have catastrophic consequences. Interoceptive exposure (IE; repeated exposure to feared arousal sensations) has been shown to decrease AS. The 33-item Hyperventilation Questionnaire (HVQ; Rapee & Medoro, 1994) measures state levels of cognitive, affective, and somatic responses to IE and arousal induction exercises more generally. The aim of the present set of studies was to develop and evaluate a brief version of the HVQ, the HVQ-B, in order to facilitate its use in research and clinical settings. In Study 1, three existing data sets that used the long version of the HVQ were combined to select the items to be retained for the HVQ-B. In Study 2, the 18-item HVQ-B was administered and its psychometric properties were evaluated. In Study 3, a confirmatory factor analysis (CFA) was performed on the 18 items of the HVQ-B. The HVQ-B demonstrated excellent psychometric properties, and accounted for most of the variance of the questionnaire's longer version. CFA indicated a reasonably good fit of the three-factor measurement model. Finally, the HVQ-B was able to distinguish between responses to arousal induction exercises by high versus low AS participants. The HVQ-B is a useful tool to assess cognitive, affective, and somatic responsivity to arousal sensations in both research and practice.
... argeted a peak BAC of 0.055% (Stewart et al., 2005). Placebo drinks (cranberry juice only) were matched for volume with the alcohol drinks. To provide taste and smell cues of alcohol for the placebo participants, we spread a small amount of vodka around the rim of each glass and a few drops of vodka were placed on the top surface of each drink (cf. MacDonald, Stewart, Hutson, Rhyno, & Loughlin, 2001 ). No additional visual cues were provided, as recommended by Ross and Pihl (1989), to avoid excessive experimental demand characteristics. As in Stewart et al. (2005), beverages were consumed steadily over 20 –25 min, depending on volume. Participants then rested for 20 –25 min to permit alcohol absorption. A postdrinking baseline hear ...
... the VLT play session, participants provided a post-VLT play BAC reading and completed a second VAS subjective intoxication measure. Smoking was not permitted during testing. Participants were debriefed about their beverage condition status, including an explanation to placebo participants as to the nature and necessity of the placebo deception (cf. MacDonald et al., 2001). If a participant was in the placebo condition, any winnings were paid out and he or she was sent home. Alcohol participants remained until BAC reached 0.04%. Taxi chits were available for transportation home if a ride had not been previously arranged. ...
The authors examined heart-rate responses to alcohol consumption and video lottery terminal (VLT) play. Regular VLT players (30 probable pathological gamblers [PPGs]; 30 nonpathological gamblers [NPGs]) were randomized to an alcohol (mean postdrinking blood alcohol concentration = 0.056%) or placebo condition. Heart rate was recorded at pre- and postdrinking baselines and during VLT play. Consistent with an earlier study, alcohol-condition participants displayed elevated heart rates relative to placebo-condition participants only at postdrinking and VLT play. Moreover, alcohol-condition participants showed a greater heart rate increase to VLT play than did placebo-condition participants. However, PPGs were not more susceptible to alcohol- and/or VLT play-induced heart rate accelerations than were NPGs. Implications for gambling/alcohol-disorder comorbidity are discussed.
... However, this did not rule out the possibility that alcohol expectancy might exert additional influences beyond those observed in the alcoholic beverage conditions in the MacDonald et al.'s (2000) study. Thus, we conducted an additional study (MacDonald et al., 2001) where high AS individuals were assigned to one of three conditions: alcohol (pharmacology + expectancy), placebo (expectancy alone), and control (no expectancy, no pharmacology). Following beverage consumption and absorption, participants underwent the same 3-min voluntary hyperventilation challenge used in our previous study and reported on their somatic, affective, and cognitive responses to the hyperventilation challenge. ...
Le présent article résume notre programme de recherche sur la sensibilité à l’anxiété (SA) – un facteur dispositionnel cognitif et affectif impliquant des craintes de sensations liées à l’anxiété en raison de croyances selon lesquelles ces sensations entraînent des conséquences catastrophiques. La SA et ses dimensions d’ordre inférieur sont considérées comme des facteurs transdiagnostiques de risque ou de maintien des troubles émotionnels et des troubles addictifs. La compréhension des mécanismes par lesquels la SA exerce ses effets peut révéler des cibles d’intervention clés pour les programmes de prévention et de traitement axés sur la SA. Dans le présent article, je passe en revue les recherches fondamentales que nous avons menées pour comprendre les mécanismes qui relient la SA à ces troubles et à leurs symptômes. Je décris également les interventions transdiagnostiques ciblées sur la SA et j’illustre la manière dont la recherche fondamentale a permis d’orienter le contenu de ces interventions. Enfin, je passe en revue les projets en cours dans mon laboratoire et je souligne les orientations futures importantes dans ce domaine. Bien que des progrès considérables aient été réalisés au cours des trois dernières décennies et que la recherche ait considérablement fait avancer notre compréhension de la SA en tant que facteur transdiagnostique, de nombreuses questions restent en suspens. Les réponses devraient nous aider à affiner les interventions afin d’en faire bénéficier au maximum les personnes qui ont une grande peur d’avoir peur.
... or affective, and .80 for cognitive, .92 for somatic; Rapee & Medoro, 1994). In addition, the HVQ has been shown to discriminate between high-and low-AS participants when used as a measure of response to hyperventilation challenge (i.e., another way of inducing physiological arousal in IE exercises; A. B. MacDonald, Baker, Stewart, & Skinner, 2000;A. B. MacDonald, Stewart, Hutson, Rhyno, & Loughlin, 2001;Rapee & Medoro, 1994). While labeled the "Hyperventilation Questionnaire" because it was developed for use with lab-based hyperventilation challenge research (Rapee & Medoro, 1994), its item and subscale content make it appropriate for use in assessing reactions to a wide range of IE activities, including running. ...
A brief cognitive-behavioral treatment intervention that included an interoceptive exposure (IE) component was previously demonstrated effective in decreasing fear of anxiety-related sensations in high anxiety-sensitive (AS) women (see Watt, Stewart, Birch, & Bernier, 2006). The present process-based study explored the specific role of the IE component, consisting of 10 minutes of physical exercise (i.e., running) completed on 10 separate occasions, in explaining intervention efficacy. Affective and cognitive reactions and objective physiological reactivity to the running, recorded after each IE trial, were initially higher in the 20 high-AS participants relative to the 28 low-AS participants and decreased over IE trials in high-AS but not in low-AS participants. In contrast, self-reported somatic reactions, which were initially greater in the high-AS participants, decreased equally in both AS groups over IE trials. Findings were consistent with the theorized cognitive and/or habituation pathways to decreased AS.
... or affective, and .80 for cognitive, .92 for somatic; Rapee & Medoro, 1994). In addition, the HVQ has been shown to discriminate between high-and low-AS participants when used as a measure of response to hyperventilation challenge (i.e., another way of inducing physiological arousal in IE exercises; A. B. MacDonald, Baker, Stewart, & Skinner, 2000;A. B. MacDonald, Stewart, Hutson, Rhyno, & Loughlin, 2001;Rapee & Medoro, 1994). While labeled the "Hyperventilation Questionnaire" because it was developed for use with lab-based hyperventilation challenge research (Rapee & Medoro, 1994), its item and subscale content make it appropriate for use in assessing reactions to a wide range of IE activities, including running. ...
A brief cognitive-behavioral treatment intervention that included an interoceptive exposure (IE) component was previously demonstrated effective in decreasing fear of anxiety-related sensations in high anxiety-sensitive (AS) women (see Watt, Stewart, Birch, & Bernier, 2006). The present process-based study explored the specific role of the IE component, consisting of 10 minutes of physical exercise (i.e., running) completed on 10 separate occasions, in explaining intervention efficacy. Affective and cognitive reactions and objective physiological reactivity to the running, recorded after each IE trial, were initially higher in the 20 high-AS participants relative to the 28 low-AS participants and decreased over IE trials in high-AS but not in low-AS participants. In contrast, self-reported somatic reactions, which were initially greater in the high-AS participants, decreased equally in both AS groups over IE trials. Findings were consistent with the theorized cognitive and/or habituation pathways to decreased AS.
... These inconsistent findings suggest that the association between AS and problematic drinking is complex. Namely, research shows that alcohol use leads to physiological changes that individuals with elevated AS should find aversive [18,19]. For example, alcohol has been shown to mimic symptoms of anxious arousal (i.e., rapid heart rate, blushing), especially in the early stages of drinking [18]. ...
Tension reduction theory states that persons high in anxiety sensitivity (AS) are particularly sensitive to alcohol's anxiolytic effects and thus may engage in problematic drinking to reduce distress. However, the literature is mixed, suggesting a complex AS pathway to problematic drinking. Elevated AS may promote drinking to alleviate anxiety, while alcohol's initial aversive physiological effects (e.g., increased heart rate) and potentially negative outcomes may deter use among those high in AS. For anxiety sensitive persons to drink, they must temporarily disregard alcohol's negative effects and instead focus on the immediate tension-reducing effects of drinking. Accordingly, anxiety sensitive individuals, who act impulsively when anxious (i.e., negative urgency), may be at risk for heavy drinking and experiencing alcohol-related problems. The goal of our study was to test this prediction. Given that gender differences have been consistently documented in the alcohol use literature, we also examined gender as a secondary moderator. Method: Undergraduates (N=346) completed self-reports of AS, negative urgency, and drinking habits. Results: Moderation analyses revealed that AS positively predicted alcohol-related problems, but only when negative urgency was elevated and this was true for men but not for women. Counter to predictions, the effect of AS on alcohol use was not moderated by negative urgency. However, gender did moderate the AS-alcohol use association, such that AS was negatively associated with alcohol use in men, but was unrelated in women. Conclusions: We found partial support for our hypotheses. Our findings place anxiety sensitive men, who are also high in negative urgency, at unique risk for alcohol-related problems. Clinical interventions may benefit from concurrently targeting negative urgency to reduce problematic drinking risk among anxiety sensitive men.
... AS has also been shown to predict reactivity to nicotine withdrawal [ 110,111 ] and the tendency to rapidly return to smoking during quit attempts [ 112 ] . Often described as an arousal-accelerating factor [ 99,113 ] , AS appears to not only render individuals susceptible to high levels of arousal in normal stressful situations, but also in response to acute and chronic drug withdrawal, physiologic states that are easily dampened by the pharmacologic properties of alcohol and benzodiazepines [ 114 ] . ...
The emphasis made on the significance of personality in the development of substance use problems has varied substantially through the years. Although early research has focused on identifying a single personality trait that conferred risk for substance use and misuse, recent research has highlighted the complex nature and heterogeneity of substance use behaviours and profiles, identifying a number of traits and risk pathways to substance use problems. This chapter reviews the evidence which provides support for the important aetiological role of a number of personality traits in the development and maintenance of substance use problems. Four personality-based causal pathways to substance misuse are proposed that help to explain some of the underlying mechanisms linking substance misuse with other mental disorders. Finally, implications for prevention and clinical practise are discussed.
... It is known that instructional sets or created expectancies may serve as important moderators for the physiological and subjective responses to interoceptive challenges (MacDonald et al. 2001;Rapee et al. 1986;Telch et al. 2010; van der Molen and van den Hout 1988). In a study by Telch et al. (2011), high-and low-AS participants received single inhalations of room air vs. 35% CO 2 while being instructed that CO 2 will lead to arousal vs. relaxation. ...
This study aimed to test how expectations and anxiety sensitivity influence respiratory and autonomic responses to caffeine.
The current study investigated the effects of expected vs. unexpected caffeine ingestion in a group of persons prone to the anxiety-provoking effect of caffeine (high anxiety sensitive persons, that is, persons scoring at least one SD above the mean on the Anxiety Sensitivity Index (Peterson and Reiss 1992)) as compared to low-anxious controls.
Autonomic arousal (heart rate, skin conductance level), respiratory responding (expired CO2, minute ventilation), and subjective report were assessed in high and low anxiety sensitive participants immediately after beverage consumption and at absorption peak (30 min post-consumption) in four separate sessions during which either coffee (expectation of caffeine) or bitter lemon soda (no expectation of caffeine) was crossed with 4 mg/kg caffeine vs. no drug.
High and low anxiety sensitive persons showed comparable autonomic arousal and symptom reports to caffeine which was modulated by expectation, i.e., greater for coffee. Respiratory responding (CO2 decrease, minute ventilation increase) was more accentuated when caffeine was both expected and administered in the low anxiety sensitive group but more accentuated when caffeine was unexpectedly administered in the high anxiety sensitive group. Autonomic arousal and respiratory effects were observable within a few minutes after caffeine administration and were most pronounced at maximum absorption.
The results highlight the modulating role of expectancies in respiratory responding to caffeine in low vs. high anxiety sensitive persons and might have important implications for the better understanding of unexpected panic attacks.
... Some studies have found that the belief that one was consuming alcohol, even when one was actually consuming a placebo, was enough to lower feelings of anxiety among anxiety-disordered patients (Abrams, Kushner, Lisdahl, Medina, & Voight, 2001;Lehman, Brown, Palfai, & Barlow 2002). On the other hand, research by MacDonald, Stewart, Hutson, Rhyno, and Loughlin (2001) conducted with participants high in anxiety sensitivity did not support a cognitively-mediated tension reduction effect of alcohol. The researchers actually found a ''reverse placebo'' effect, where high AS participants in a placebo condition, who had expectations of alcohol-induced tension reduction, but did not benefit from alcohol's physiological tension-reduction properties, appeared to have even higher levels of anxiety than participants in a control condition where they neither received nor expected alcohol. ...
The relationship between anxiety and alcohol use is a topic of great theoretical and practical interest for both scientists interested in the nature and causes of psychopathology and practitioners working with anxious and/or alcohol abusing clients. Although it has been clearly established that anxiety disorders and alcohol use disorders are highly ‘‘comorbid’’ or co-occurring conditions (e.g., see Kushner, Abrams & Borchardt, 2000a for a review), the relationship between the symptoms or behaviors involved in each disorder (e.g., feelings of anxiety and levels of alcohol use) has not been as extensively reviewed. This chapter will review recent empirical evidence linking anxiety and alcohol at both the behavioral and disorder level to determine if similar conclusions can be derived regarding their relationship from data at both of these levels of enquiry. We will first briefly describe epidemiological studies linking anxiety disorders and alcohol use disorders. Then we will examine some of the etiological theories of the relationship between anxiety and alcohol use and their disorders, with a review of the empirical evidence supporting each theory. Next, some specific factors moderating and mediating the relationship between anxiety and alcohol use will be explored, with an emphasis on individual differences and specific processes involved in the relationship. A brief discussion of the differences between factors affecting onset, maintenance, and relapse in the anxiety and alcohol relationship will follow. The latest empirical evidence and thoughts about treating both alcohol use and anxiety related problems will also be reviewed. Finally, we conclude the chapter with some remarks about where the field stands and directions that future research in this area might profitably take.
... The samples have been drawn from both clinical (Kushner et al., 2001, this issue) and nonclinical (e.g., Zvolensky et al., 2001, this issue) sources. Methodologies range from self-report (e.g., DeHaas et al., 2001, this issue) to lab-based experimental designs (e.g., MacDonald et al., 2001, this issue) to clinical trials (Brown et al., 2001, this issue). The studies also span a wide variety of substances of abuse including alcohol (e.g., Kushner et al., 2001, this issue), cigarettes (e.g., Zvolensky et al., 2001, this issue), marijuana (e.g., Comeau et al., 2001, this issue), and analgesics (e.g., Asmundson, Wright, Norton, & Veloso, 2001, this issue). ...
Anxiety sensitivity (AS) is a cognitive, individual difference variable characterized by a fear of arousal-related bodily sensations due to beliefs that such sensations are signs of impending catastrophic physical, psychological, or social outcomes. AS has been linked to increased risk for the development and maintenance of panic attacks and anxiety disorders, and more recently has been related to risk for other psychopathological conditions including those related to substance misuse. This article introduces a special issue of Addictive Behaviors focusing on cutting edge findings on the relations of AS to substance use and abuse. We set the stage for the following series of eight novel empirical papers by providing a review of background on the ways in which AS has been hypothetically linked to increased risk for the development of substance abuse and addiction. We also consider whether AS might be differentially related to risk for abuse of specific classes of drugs with different pharmacological effects (e.g., depressants vs. stimulants). Finally, we consider how AS might be related to substance use disorder maintenance or relapse risk through its putative effects in increasing drug withdrawal severity and in lowering tolerance for withdrawal symptoms. Our overriding goal in writing this Introduction was to provide an organizational template for integrating the featured studies and to recommend promising directions for future work into the association of AS and substance use-related problems.
... Indeed, administration of antidepressant drugs (Romeo et al. 1998;Uzunova et al. 1998) or hormone replacement therapy (Florio et al. 2001), treatments that relieve some of the symptoms associated with anxiety or affective disorders, changes the concentration of 3a,5a-TH PROG in the plasma (and probably in the brain) of patients with such conditions. Ethanol consumption has been shown to be increased in women with premenstrual syndrome (Tobin et al. 1994;Chuong and Burgos 1995;Allen 1996) as well as in individuals with chronic stress (Thyer et al. 1986;MacDonald et al. 2001), conditions associated with marked fluctuations in the plasma content of 3a,5a-TH PROG (Rapkin et al. 1997;Girdler et al. 2001;Rasgon et al. 2001). Thus, the putative changes in the mesocorticolimbic dopaminergic system associated with these conditions may trigger the changes in ethanol intake. ...
The effect of endogenous 3alpha-hydroxy-5alpha-pregnan-20-one (3alpha,5alpha-TH PROG) on the modulation of mesocortical dopamine extracellular concentration by ethanol was investigated by microdialysis in rats. Intraperitoneal injection of progesterone (5 mg/kg, once a day for 5 days) increased the cortical content of 3alpha,5alpha-TH PROG and potentiated the biphasic effect of acute intraperitoneal administration of ethanol on dopamine content. A dose of ethanol (0.25 g/kg) that was ineffective in naïve rats induced a 55% increase in dopamine extracellular concentration in rats pretreated with progesterone. This increase was similar to that induced by a higher dose (0.5 g/kg) of ethanol in naïve rats. Administration of ethanol at 0.5 g/kg to progesterone-pretreated rats inhibited dopamine content by an extent similar to that observed with an even higher dose (1 g/kg) in naïve rats. The administration of the 5alpha-reductase inhibitor finasteride (25 mg/kg, subcutaneous), together with progesterone, prevented the effects of the latter, both on the cortical concentration of 3alpha,5alpha-TH PROG and on the modulation by ethanol of dopamine content. These data suggest that 3alpha,5alpha-TH PROG contributes to the action of ethanol on the mesocortical dopaminergic system. They also suggest that physiological fluctuations in the brain concentrations of neuroactive steroids associated with the oestrous cycle, menopause, pregnancy and stress may alter the response of mesocortical dopaminergic neurons to ethanol.
... However, animals permitted to drink ethanol immediately upon their removal from the apparatus, exhibited a dose-dependent reduction in the occurrence of retreat behaviors in the runway [46]. The delayed timing of the ethanol consumption relative to the cocaine infusion suggests that the ethanol may have acted to reduce the intensity or onset of the negative properties of the cocaine either via its own inherent reinforcing properties [15,39,41,48,60,65] or its well documented anxiogenic effects [5,57,90]. ...
Over the past decade, data collected in our laboratory have demonstrated that self-administered cocaine produces Opponent-Process-like behavioral effects. Animals running a straight alley once each day for IV cocaine develop over trials an approach-avoidance conflict about re-entering the goal box. This conflict behavior is characterized by a stop in forward locomotion (usually at the very mouth of the goal box) followed by a turn and 'retreat' back toward the goal box. The results of a series of studies conducted over the past decade collectively suggest that the behavioral ambivalence exemplified by rats running the alley for IV cocaine stems from concurrent and opponent positive (rewarding) and negative (anxiogenic) properties of the drug--both of which are associated with the goal box. These opponent properties of cocaine have been shown to result from temporally distinct affective states. Using a conditioned place preference test, we have been able to demonstrate that while the initial immediate effects of IV cocaine are reinforcing, the state present 15 min post-injection is aversive. In our most recent work, the co-administration of IV cocaine with either oral ethanol or IV heroin was found to greatly diminish the development and occurrence of retreat behaviors in the runway. It may therefore be that the high incidence of co-abuse of cocaine with either ethanol or heroin, stems from the users' motivation to alleviate some of the negative side effects of cocaine. It would seem then that the Opponent Process Theory has provided a useful conceptual framework for the study of the behavioral consequences of self-administered cocaine including the notion that both positive and negative reinforcement mechanisms are involved in the development and maintenance of cocaine abuse.
Decades of research have tested the hypothesis that alcohol consumption buffers against the effects of stress. Despite this large body of literature, the evidence from carefully controlled laboratory studies in which alcohol is administered and negative affect is measured in response to a stressor is mixed. The goal of the current meta-analysis was to quantitatively summarize laboratory studies of alcohol's stress response dampening effects and test theoretical and methodological factors that explain variation in effect sizes across studies. A literature search identified 52 studies that administered alcohol and measured negative affect, as defined by self-report and/or psychophysiological response to a stressor. The results showed post-stressor negative affect was significantly lower in the alcohol condition compared to the control conditions (placebo and control), d = -.38, 95% CI [-.56, -.21], k = 130, m = 50. For changes in pre-to-post stressor affect, there was evidence of a small, but not significant, difference between the conditions such that negative affect increased slightly less in the alcohol condition, d = .49, 95% CI [.22, .77], k = 54, m = 27, compared to the control conditions, d = .60, 95% CI [.39, .80], k = 65, m = 26. Moderator analyses did not yield significant results but highlighted some areas for further research. Rather than providing definitive results on the topic of stress response dampening, this meta-analysis indicates several opportunities for refinement of method and theory to continue to improve the science in this area of research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Alkoholabhängigkeit tritt bei komorbider Persönlichkeitsstörung (PS), insbesondere bei Borderline-Persönlichkeitsstörung (BPS), häufiger und schwerer ausgeprägt auf. Erkenntnisse über spezifische Trinkkonsum-Muster von Alkoholabhängigen mit einer PS sollen zur spezifischen Suchttherapie für diese Patienten beitragen.
Bei 147 Alkoholabhängigen wurden während der stationären Alkoholentwöhnung (16 Wochen) die Patienten mit komorbider PS (speziell BPS) mittels SKID-II ermittelt. Die Gruppen der Patienten mit und ohne PS (speziell BPS) wurden verglichen hinsichtlich Soziodemografie, Drogenkonsum und mittels Selbstbeurteilungsverfahren zur Erwartung positiver Alkoholwirkungen (AEQ), Selbstaufmerksamkeit (DFS), Depressivität (BDI), Hochrisiko-Trinksituationen (IDTSA) und Abstinenzzuversicht/ Selbstwirksamkeit (AASE).
Bei 37 % der Alkoholabhängigen wurde eine PS und bei 12% speziell eine BPS diagnostiziert. Patienten mit PS und besonders die mit einer BPS waren in früherem Lebensalter alkoholabhängig geworden und sie konsumierten häufiger Drogen. Es gab bei PS (BPS) keine Besonderheiten bezüglich positiven Alkoholwirkungserwartungen. Patienten mit einer PS (BPS) zeigten erhöhte Depressivität und sie tranken häufiger in Situationen mit negativen Affekten. Bei der BPS war die dysfunktionale Selbstaufmerksamkeit erhöht. Patienten mit BPS hatten eine größere Versuchung, in positiven sozialen Situationen zu trinken, ohne dass ihre Abstinenzzuversicht dabei geringer ausgeprägt war. Ferner werden altersspezifische Aspekte des Trinkverhaltens diskutiert.
Früherer Abhängigkeitsbeginn und häufigere Polytoxikomanie bei Alkoholabhängigen mit PS erfordern komplexeTherapieansätze in der Suchttherapie.
Es ist bekannt, dass die Menge des Alkoholkonsums mit dem Ausmaß positiver Alkoholwirkungserwartungen korreliert. Abgesehen davon sind diese Erwartungen möglicherweise weniger persönlichkeitsbedingt, sondern eher bedingt durch soziokulturell beeinflusste und individuelle Erwartungen vor dem ersten Trinkbeginn und durch prägende erste Trinkerfahrungen.
Persönlichkeitsbedingt dysfunktionale Denk- und Verhaltensmuster verursachten bei Patienten mit komorbider PS verstärkt negative Affekte und sie tranken in solchen Situationen häufiger als Coping. In der Therapie sind kognitive Umstrukturierung der negativen Affekte und eine Psychoedukation spezifisch zu den jeweiligen PS geeignete psychotherapeutische Verfahren.
Dysfunktionale Selbstaufmerksamkeit führt häufig zu negativen Gefühlen. Allgemein wird Alkohol gegen die dysfunktionale Selbstaufmerksamkeit konsumiert, die wiederum bei BPS besonders erhöht war. Spezifische Strategien, z.B. Aufmerksamkeits-lenkung, sind dagegen notwendig.
Bei BPS wirkt Alkohol in positiven sozialen Situationen besonders als Verstärkermotiv, was durch die erhöhte Impulsivität bedingt sein könnte. Sensibilisierung der Patienten für dieses Trinkverhalten ist für die Rückfallprophylaxe bedeutsam.
Die in diesen sozialen Situationen bei BPS als nicht geminderte Abstinenzzuversicht könnte an beeinträchtigter Selbsteinschätzung und Selbstwahrnehmung liegen. Da diese Zuversicht Teil der Selbstwirksamkeit in der Suchttherapie ist, ist sie auch als positiv zu bewerten.
Insgesamt sollten Selbstaufmerksamkeit und Verstärkermotive bei der Borderline-spezifischen Suchttherapie besonders berücksichtigt werden.
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 depression symptoms and then through negatively-reinforced drinking motives (i.e., drinking to cope with negative affect and drinking to conform).DesignCross-sectional single- and chained-mediation models were tested.SettingSelf-report measures were completed in clinics at Florida State University and the University of Vermont, USA.ParticipantsParticipants consisted of 523 adult daily cigarette smokers (M age = 37.23, SD = 13.53; 48.6% female).MeasurementsAs part of a larger battery of self-report measures, participants completed self-report measures of AS, generalized anxiety, depression, drinking motives, and alcohol problems.FindingsChained mediation was found from AS to alcohol problems through generalized anxiety then through drinking to cope with negative affect (B = .04, 90% confidence interval [CI; .004, .10]). Chained mediation was also found from AS to alcohol problems through depression then through drinking to cope with negative affect (B = .11, 90% CI [.05, .21]) and, separately, through socially motivated drinking (B = .05, 90% CI [.003, .11]).Conclusions
Anxiety sensitivity and alcohol problems are indirectly related through several intervening variables, such as through generalized anxiety or depression and then through drinking to cope with negative affect.
Anxiety disorders are the most common mental health condition and frequently co-occur with a variety of health risk factors, such as physical inactivity, cigarette smoking, and alcohol consumption. As such, untreated anxiety and increased risk for engagement in these health risk habits can further increase risk for later-onset chronic disease and complications in disease management. Contemporary studies have identified unique temporal relationships between the onset of specific anxiety disorders with smoking and alcohol use disorders. Incorporating exercise with evidence-based treatments for anxiety is emerging and promising in enhancing treatments for anxiety-related conditions. Likewise, substance use treatment programs may benefit from the detection and management of anxiety. Collaborative care models for anxiety may provide the needed systems-based approach for treating anxiety more effectively in primary and specialty care medical settings. Based on a qualitative review of the literature, this article summarizes the current research on the associations between anxiety, health risk factors, and the risk for chronic diseases. The authors also offer suggestions for future research that would help in better understanding the complex relationships between the role anxiety plays in the vulnerability for and management of physical inactivity and substance use.
This paper describes the development of and pilot results for an alcohol abuse early intervention program targeting at-risk Mi'kmaq youth conducted in partnership with the communities in which these youth live and the schools which they attend. This intervention was based on a previously-established, successful psychoeducational and cognitive-behavioral approach for at-risk adolescent drinkers from the majority culture that focuses on dif-ferent personality pathways to alcohol abuse in youth (Conrod, Stewart, Comeau, & MacLean, 2006). Through partnership and collaboration with two Mi'kmaq communities, the original inter-vention was adapted to be culturally appropriate for Mi'kmaq youth. The culturally-adapted intervention included traditional Mi'kmaq knowledge and teachings in order to make the program as meaningful and relevant as possible in the partner commu-nities (Comeau et al., 2005). The pilot results were encourag-ing. Compared to pre-intervention, students who participated in the intervention drank less, engaged in less binge-drinking episodes (i.e., 5 drinks or more/occasion), had fewer alcohol-related problems, and were more likely to abstain from alcohol use. Moreover, students who participated in the intervention also reduced their marijuana use at four-month post-intervention, even though the intervention was specifically designed to tar-get alcohol misuse. No such significant changes were observed in a non-random control group of eligible students who did not participate in the intervention. Future research should determine if this intervention is effective for at-risk youth in other First Na-tions communities across Canada, and whether the promising, but preliminary results with marijuana mean that the benefits of the intervention might extend to adolescents' use of substances other than alcohol.
Anxiety sensitivity (AS) is a cognitive, individual difference variable that refers to the fear of arousal-related bodily sensations. Persons with high AS fear these sensations because they believe the sensations are signs of impending catastrophic events. AS has been linked to increased alcohol consumption and also risky drinking motives, including coping and conformity motives. This paper summarizes statistical modeling studies and experimental research on the functional relationships between AS and drinking motives and alcohol consumption. AS functions as a risk factor that sets the stage for negative reinforcement by alcohol use. Whether alcohol use becomes a method of coping with AS depends on multiple risk factors and motivations. We propose an integrated model to account for the observed relationships and to guide future research. In addition, we identify key methodological limitations and directions for future research.
The eight articles in this special issue on anxiety sensitivity (AS) and substance abuse provide provocative new information on the relationships, or lack of relationships, between AS and several types of substance use and abuse. The eight articles provide data that extend our understanding of the role of AS in substance abuse with younger people, people who use substances other than alcohol, people who have disorders comorbid with substance use disorders, and people who experience chronic headaches. In addition, one of the articles attempts to determine how AS develops in relationship to parental substance abuse. Finally, several of the studies show that the three Anxiety Sensitivity Index (ASI) subscales (physical concerns, social concerns, and psychological concerns) are uniquely associated with different aspects of substance use/abuse. Each of the articles is discussed as to its merits and potential domains that may require additional research. Finally, several general suggestions are provided for new directions that research on the relations of AS and substance use/abuse should take.
Anxiety assessment by questionnaire provides information for the dentist and may also confer a psychological benefit on patients. This study tested the hypothesis that informing dentists about patients' dental anxiety prior to commencement of treatment reduces patients' state anxiety. A randomized controlled trial was conducted involving eight General Dental Practitioners in North Wales. Participants included patients attending their first session of dental treatment, and accumulating a score of 19 or above, or scoring 5 on any one question, of the Modified Dental Anxiety Scale (MDAS). Patients (n = 119) completed Spielberger's state anxiety inventory (STAI-S) pre- and post-treatment and were randomly allocated to intervention (dentist informed of MDAS score) and control (dentist not informed) groups. Intervention patients showed greater reduction in mean change STAI-S scores (F[1,119] = 8.74, P < 0.0001). Providing the dentist with information of the high level of a patient's dental anxiety prior to treatment, and involving the patient in this, reduced the patient's state anxiety.
To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders.
Systematic literature search using PubMed, PsycLit, and the Cochrane Library.
108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.
The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.
21.
Goldman M. S., Darkes J. Alcohol expectancy multiaxial assessment: A memory network-based approach. Psychological Assessment 2004; 16: 4–15View all references argued that all three basic alcohol-expectancy factors can be assessed with a brief questionnaire (AEMax), related to the circumplex model of emotion. I argue that negative reinforcement, one of the three basic expectancy factors, is not assessed with the AEMax. Importantly, negative reinforcement is positively related to problem drinking while sedation (the AEMax-factor that comes closest) is not. In a new dataset (from 119 students, collected in 2002), I demonstrate that sedation is related to negative expectancies and not to negative reinforcement. Different ways to assess all major expectancy factors are proposed.
Female substance abusers recruited from the community were randomly assigned to receive 1 of 3 brief interventions that differentially targeted their personality and reasons for drug use. The 90-min interventions were: (a) a motivation-matched intervention involving personality-specific motivational and coping skills training, (b) a motivational control intervention involving a motivational film and a supportive discussion with a therapist, and (c) a motivation-mismatched intervention targeting a theoretically different personality profile. Assessment 6 months later (N = 198) indicated that only the matched intervention proved to be more effective than the motivational control intervention in reducing frequency and severity of problematic alcohol and drug use and preventing use of multiple medical services. These findings indicate promise for a client–treatment matching strategy that focuses on personality-specific motives for substance abuse.
Investigated the role of alcohol, expectancy, and cognitive labeling in producing positive emotional changes following moderate alcohol consumption. In a 2–3 factorial design, 96 male normal drinkers (undergraduates) were (a) given either an alcoholic (.45 g ethanol/kg) or a nonalcoholic beverage, (b) instructed that they were receiving either an alcoholic or a nonalcoholic beverage, and (c) either informed or not informed of common physical sensations that result from a moderate dose of alcohol. Ss were then exposed to humorous stimuli, and their laughter and self-reports of mood were measured. Hypotheses based on extensions to alcohol intoxication of the cognitive-attributional components of S. Schachter's (1964) theory of emotion were not supported. Although both instructing Ss that they had received alcohol and actually administering alcohol increased Ss' reports of positive affect, only the beverage content instruction influenced Ss' laughter. Implications for current conceptualizations of the emotional and behavioral effects of alcohol consumption are discussed. (35 ref)
Anxiety sensitivity (AS) is the fear of anxiety sensations which arises from beliefs that these sensations have harmful somatic, social, or psychological consequences. Over the past decade, AS has attracted a great deal of attention from researchers and clinicians with more than 100 peer-reviewed journal articles published. In addition, AS has been the subject of numerous symposia, papers, and posters at professional conventions. Why this growing interest? Theory and research suggest that AS plays an important role in the etiology and maintenance of many forms of psychopathology, including anxiety disorders, depression, chronic pain, and substance abuse. Bringing together experts from a variety of different areas, this volume offers the first comprehensive state-of-the-art review of AS--its conceptual foundations, assessment, causes, consequences, and treatment--and points new directions for future work. It will prove to be an invaluable resource for clinicians, researchers, students, and trainees in all mental health professions.
Men at risk for alcoholism appear to be cardiovascularly hyperreactive to stressors; high doses of alcohol have been found to significantly dampen this hyperreactivity. The present study examined the effects of various doses of alcohol on cardiovascular reactivity in high- versus low-risk men. Cardiovascular reactivity to a stressor (unavoidable shock) was examined in men with multigenerational family histories of alcoholism and in family history negative men while they were sober and after they had consumed one of five alcohol doses (active placebo, 0.50, 0.75, 1.00 or 1.32 ml 95% USP alcohol/kg body weight). No significant placebo effects were observed in the active placebo condition. Furthermore, the cardiovascular reactivity dampening effect in high-risk men was evident only at moderate to high doses of alcohol, suggesting that men at high risk for the development of alcoholism must consume moderately high doses of alcohol in order to obtain this potentially reinforcing consequence.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Alcohol consumption and alcohol expectation were separately evaluated in terms of effects on psychophysiological levels prior to stress and reduction of the magnitude of response to stress. 96 male, experienced drinkers were assigned to 8 conditions in a between-Ss design in which beverage consumed (alcohol or tonic), beverage expected (alcohol or tonic), and stressor (self-disclosing speech or threat of shock) were manipulated. Dosage for Ss receiving alcohol was 1 g ethanol/kg. Results indicate strong effects of alcohol consumption on prestress levels, consisting of accelerated heart rate (HR), lower HR variability, higher skin conductance, longer pulse transmission time (PTT), higher "cheerfulness" and lower "anxiety" ratings. Alcohol consumption significantly reduced the magnitude of the HR, PTT, and anxiety responses of Ss to the stressors. No effects attributable to alcohol expectation were found. Results are integrated with the existing literature concerned with pharmacological and cognitive effects of alcohol as they pertain to stress, psychophysiological responses to stress, and tension reduction. (32 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Reviews the book,
Psychophysiological recording (2nd ed.) by R. M. Stern, W. J. Ray, and K. S. Quigley (2001). In 1980, Stern, Ray and Davis published their book
Psychophysiological recording. This was one of the first highly readable texts for those beginning the study of psychophysiology, and it soon became a classic. Now, 21 years later, the second edition has appeared. It is an expanded and updated version of the first edition and takes into account the technological advances made over the last two decades. The book is divided into three main parts. The first part deals with background material the authors consider essential to an understanding of psychophysiology. The second part is concerned with the activity of specific organs and systems accessible to noninvasive measurement. The third part of the book concentrates on applications of psychophysiological recordings. All in all, the book is a concise and scholarly introduction into the difficult field of psychophysiology. The text is highly readable. The various attractive illustrations facilitate understanding. Its major strength is the coverage of theoretical concepts and, especially, of measurement issues concerning the activity of various organs and systems. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the effects of anxiety-sensitivity (AS) levels, and 1.00 ml/kg alcohol, on autonomic and subjective-emotional responses to aversive stimulation (i.e., noise bursts). Ss were 30 university women divided into 3 AS groups (high, moderate, and low), on the basis of Anxiety Sensitivity Index (ASI) scores. When sober, high-AS women provided higher emotional arousal ratings while anticipating the noise bursts than did low-AS women. Alcohol dampened the noise burst-anticipation ratings, particularly in the high-AS group. ASI scores were positively correlated with degree of sober skin conductance level (SCL) reactivity and with degree of alcohol dampening of SCL reactivity. Thus, high-AS women may use alcohol to normalize their anticipatory emotional and electrodermal overreactivity to threat. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
While expectancies are considered an important factor in the etiology of addiction, less is known about expectancies for drugs other than alcohol, and there has been little effort to systematically incorporate expectancies into programs designed to change addictive behavior. This report reviews the expectancy construct and the role of expectancy in the development of substance abuse. Cognitive and behavioral strategies for changing substance use expectancies and the means by which expectancies may facilitate changes in addictive behaviors are described. Examples of strategies to incorporate expectancy-based change efforts into clinical intervention for addictive behavior are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study examines the relationship of familial and personality risk factors for alcoholism to individual differences in sensitivity to the positively and negatively reinforcing properties of alcohol. Sixteen sons of male alcoholics with multigenerational family histories of alcoholism (MFH) and 11 men who self-report heightened sensitivity to anxiety (HAS) were compared with 13 age-matched family history negative, low anxiety sensitive men (FH-LAS) on sober and alcohol-intoxicated response patterns. We were interested in the effects of alcohol on specific psychophysiological indices of “stimulus reactivity,” anxiety, and incentive reward. Alcohol significantly dampened heart rate reactivity to aversive stimulation for the MFH and HAS men equally, yet did not for the FH-LAS group. HAS men evidenced idiosyncrasies with respect to alcohol-induced changes in electrodermal reactivity to avenive stimulation (an index of anxiety/fear-dampening), and MFH men demonstrated elevated alcohol-intoxicated resting heart rates (an index of psychostimulation) relative to the FH-LAS men. The results are interpreted as reflecting a sensitivity to the “stimulus reactivity-dampening” effects of alcohol in both high-risk groups, yet population-specific sensitivities to the fear-dampening and psychostimulant properties of alcohol in the HAS and MFH groups, respectively.
Individuals with social phobia are at an increased risk for alcohol problems. Individuals with social phobia could increase their risk for pathological alcohol use if they drink as a means of coping with anxiety-provoking social situations. Providing a circumscribed test of this view, we evaluate the effect of alcohol on the intensity of social phobia anxiety responses. Sixty-one individuals with social phobia gave two speech challenges in front of a group (‘social anxiety challenge’), one occurring before and one after they consumed either: (a) an alcoholic drink they were told contained alcohol (‘alcohol group’), (b) a non-alcoholic drink they were told contained alcohol (‘placebo group’), or, (c) a non-alcoholic drink they were told contained no alcohol (‘control group’). Both the alcohol group and the placebo group showed greater reduction in performance anxiety from the first to the second speech challenge than did the control group. Further, there was a strong trend in the data for the alcohol group to show greater reduction in performance anxiety from the first to the second speech challenge than did the placebo group. We concluded from these findings that the pharmacologic effects of alcohol and the belief that one consumed alcohol decrease social performance anxiety in an additive fashion. These results provide direct support for the negatively reinforcing properties of alcohol and are consistent with the view that symptom reduction may motivate alcohol use among socially phobic individuals.
The results of two studies1,2 in the Archives have been interpreted as being suggestive of reduced benzodiazepine receptor sensitivity (or, more specifically, a shift in benzodiazepine receptor "setpoint"2) resulting in reduced ɣ-aminobutyric acid (GABA) function in panic disorder, with these abnormalities possibly being pathogenic. We suggest two possible alternative or additional explanations.These Results Could Be Secondary to Chronic Alcohol Use.—In both studies,1,2 drinking history was either not assessed or not reported. Yet there is a strong relationship between alcohol abuse and the panic-related disorders.3-5 Data6-9 attest to the fact that rates of panic disorder in alcoholics and rates of alcohol abuse in patients with panic disorder are unusually high compared with the rates in the general population.10There is increasing evidence that alcohol mediates many of its pharmacologic effects through the GABA-ergic receptor system, from behavioral, electrophysiological, and ...
When the responses of 2 or more groups to the relative effects of some stimulus are compared, it is often important to adjust statistically the estimates of those effects for baseline differences among those groups. This is often the case in experiments on heart rate for animals of different ages. How should such adjustment be done? Among the competing methodologies are (a) subtract the base rate, (b) divide by the base rate, and (c) covary out the base rate. Because each can give a different answer, the choice is crucial. This article shows that this is an example of Lord's Paradox and that Rubin's Model for the measurement of causal effects allows researchers to understand what the assumptions are underlying the validity of each adjustment strategy. The answer for heart rate data is almost surely Methodology (a).
The ambiguous and variable nature of intoxication places an unpleasant burden on the providers of alcohol. It also places health educators in an unfortunate position; they are often called upon to advise providers and consumers of alcohol on consumption limits in order to avoid intoxication. Consequently, a persistent problem in health promotion is the failure to provide explicit educational messages. For example, in dealing with alcohol problems, many programs are built around the concept of the 'responsible drinker', but are reticent in stating how many drinks constitute responsible drinking. This paper can serve as a basic reference guide for a step-by-step calculation of Blood Alcohol Concentration (BAC). Tables indicating number of drinks over time and BACs for males and females of varying body weights are provided.
A meta-analysis was conducted on research investigating the effects of alcohol consumption and expectancy within the balanced-placebo design. Preliminary results indicated that both alcohol and expectancy have significant, although heterogeneous effects on behavior. Subsequent analyses were conducted to determine the factors responsible for the heterogeneity of effects. At the highest level of analysis, alcohol expectancy had strong effects on relatively deviant social behaviors and minimal effects on nonsocial behaviors. Alcohol consumption showed the opposite pattern of effects. The principal effects associated with alcohol expectancy involved increased alcohol consumption and increased sexual arousal in response to erotic stimuli. On the other hand, alcohol consumption led to significant impairment of information processing and motor performance, induced a specific set of physical sensations, resulted in general improvements of mood, and tended to increase aggression. Finally, across all studies it was observed that alcohol consumption and expectancy interacted no more frequently than would be expected by chance. These results have implications for both the theories and methods of contemporary alcohol research.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
Alcohol consumption and alcohol expectation were seperately evaluated in terms of effects on psychophysiological levels prior to stress and reduction of the magnitude of response to stress. Ninety-six male, experienced drinkers were assigned to eight conditions in a between-subjects design in which beverage consumed (alcohol or tonic), beverage expected (alcohol or tonic), and stressor (self-disclosing speech or threat of shock) were manipulated. Dosage for subjects receiving alcohol was 1 g ethanol/kg body weight. Results indicated strong effects of alcohol consumption on prestress levels, consisting of accelerated heart rate (HR), lower HR variability, higher skin conductance, longer pulse transmission time (PTT), higher 'cheerfulness' and lower 'anxiety' (ANX). This pattern of effects is related to previous unsuccessful attempts to specify a simple relationship between alcohol consumption and 'tension'. In addition, alcohol consumption significantly reduced the magnitude of the HR, PTT, and ANX responses of subjects to the stressors. No effects attributable to alcohol expectation were found. These results are integrated with the existing literature concerned with pharmacological and cognitive effects of alcohol as they pertain to stress, psychophysiological responses to stress, and 'tension reduction'.
Alcoholics have previously been found to be more sensitive to painful stimulation than controls, and more sensitive to the pain-reducing effects of alcohol. The present study was designed to examine these effects in men at high familial-genetic risk for alcoholism and controls. Subjects were assigned to one of four alcohol doses [0.135 (active placebo), 0.50, 0.75, or 1.00 ml 95% USP alcohol/kg body weight]. Ratings of the amount of discomfort and pain experienced during an aversive shock procedure were taken immediately post-shock, both while subjects were sober and after they had consumed one of the four alcohol doses. High risk men were found to rate the experience of the shock as more uncomfortable and painful overall than the low risk controls. Pharmacologically significant levels of alcohol were found to reduce or eliminate these group differences, suggesting that alcohol has a "normalizing" effect on pain and discomfort perceptions in high risk men. Only the higher doses of alcohol were found significantly to dampen subjects' shock rating scores. High risk males' increased sensitivity to pain and discomfort, combined with the negatively reinforcing effects of reducing these perceptions at moderate to high alcohol doses, may play a role in predisposing high risk males for the development of alcoholism.
This edition of the Mastery of Your Anxiety and Panic Workbook has been updated to include strategies and techniques for dealing with both panic disorder and agoraphobia. The program outlined is based on the principles of cognitive behavioral therapy (CBT) and is organized by skill, with each chapter building on the one before it. It covers the importance of recordkeeping and monitoring progress, as well as breathing techniques and thinking skills. The main focus of the treatment involves learning how to face agoraphobia situations and the often frightening physical symptoms of panic from an entirely new perspective. Self-assessment quizzes, homework exercises, and interactive forms allow patients to become active participants in treatment and to learn to manage panic attacks, anxiety about panic, and avoidance of panic and agoraphobic situations.
To the Editor. —
The results of two studies1,2 in the Archives have been interpreted as being suggestive of reduced benzodiazepine receptor sensitivity (or, more specifically, a shift in benzodiazepine receptor "setpoint"2) resulting in reduced ɣ-aminobutyric acid (GABA) function in panic disorder, with these abnormalities possibly being pathogenic. We suggest two possible alternative or additional explanations.These Results Could Be Secondary to Chronic Alcohol Use.—In both studies,1,2 drinking history was either not assessed or not reported. Yet there is a strong relationship between alcohol abuse and the panic-related disorders.3-5 Data6-9 attest to the fact that rates of panic disorder in alcoholics and rates of alcohol abuse in patients with panic disorder are unusually high compared with the rates in the general population.10There is increasing evidence that alcohol mediates many of its pharmacologic effects through the GABA-ergic receptor system, from behavioral, electrophysiological, and
Background:
This study tested whether alcohol consumption reduces anxiety and panic associated with a panic-challenge procedure.Methods:
Subjects with panic disorder were randomly assigned to consume either a moderate dose of alcohol or a nonalcoholic placebo. All subjects were told that they were drinking alcohol to control beverage expectancies. Following the beverage administration, subjects underwent a panic challenge (35% carbon dioxide) and a series of anxiety symptom assessments.Results:
Subjects who consumed alcohol reported significantly less state anxiety both before and after the challenge. In response to the challenge, subjects who consumed alcohol experienced significantly fewer panic attacks when applying liberal panic criteria; however, this effect only approached significance when applying conservative panic criteria.Conclusions:
These findings suggest that alcohol acts acutely to reduce both panic and the anxiety surrounding panic, and they lend support to the view that drinking behavior among those with panic disorder is reinforced by this effect. We suggest that this process may contribute to the high rate at which alcohol-use disorders co-occur with panic disorder.
—Stewart et al raise an im- portant point, namely, the reason patients with panic disorders have abnormal benzodiazepine receptor sensitivity. However, their suggestion that previous alcohol or benzodiazepine exposure could result in anxiogenic responses to flumazenil are but two in a range of possible causes. Before considering these, we can offer some more direct support for their contention that alcoholism may be of relevance. Their bibliography of clinical studies in this area could be usefully expanded to include a recent review that directly addresses the alcoholism/panic disorder comorbidity question and postulates several neurochemical mechanisms for this.1 Moreover, the marked similarity between the symptoms of withdrawal and panic attacks has been documented.2 A possible explanation for this is provided by recent neurochemical studies that demonstrated that acute and long-term ethanol exposure increases the sensitivity of the benzodiazepine receptor to the inverse agonist dimethoxy-methyl-β carboline-3-carboxylate (DMCM).3,4 Since ethanol exposure
"Lord's Paradox" is a term applied to a hypothetical situation illustrated by Frederic M. Lord in which Gain Score Analysis (GSA) and the Analysis of Covariance (ANCOVA) yield conflicting results in testing differential treatment effects for natural groups. This paper demonstrates that GSA and ANCOVA will always yield conflicting results unless the slopes of within group regression lines of posttest on pretest equal one. It is also pointed out that in Lord's specific hypothetical example, trait instability accounts for regression line slopes not equaling one and invalidates the ANCOVA. An analysis that corrects for this problem is demonstrated.
Evaluated a scale for measuring anxiety sensitivity (i.e., the belief that anxiety symptoms have negative consequences), the Child Anxiety Sensitivity Index (CASI), in 76 7th–9th graders and 33 emotionally disturbed children (aged 8–15 yrs). The CASI had sound psychometric properties for both samples. The view that anxiety sensitivity is a separate concept from that of anxiety frequency and that it is a concept applicable with children was supported. The CASI correlated with measures of fear and anxiety and accounted for variance on the Fear Survey Schedule for Children—Revised and the State-Trait Anxiety Inventory for Children (Trait form) that could not be explained by a measure of anxiety frequency. The possible role of anxiety sensitivity as a predisposing factor in the development of anxiety disorder in children is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background: Previous research suggests that high levels of anxiety sensitivity (AS; fear of anxiety symptoms) may constitute a risk factor for alcohol abuse. The present study evaluated the hypothesis that high AS levels may increase risk for alcohol abuse by promoting a heightened sober reactivity to theoretically relevant stressors and heightened sensitivity to alcohol's emotional reactivity dampening effects, which would negatively reinforce drinking in this population.
Methods: One hundred and two undergraduate participants (51 high AS, 51 low AS) with no history of panic disorder were assigned to either a placebo, low‐dose alcohol, or high‐dose alcohol beverage condition (17 high AS, 17 low AS per beverage condition). After beverage consumption and absorption, participants underwent a 3 min voluntary hyperventilation challenge.
Results and Conclusions: High‐AS/placebo participants displayed greater affective and cognitive reactivity to the challenge than low‐AS/placebo participants, which indicated increased fear and negative thoughts (e.g., “losing control”) during hyperventilation among sober high AS individuals. Dose‐dependent alcohol dampening of affective and cognitive reactivity to hyperventilation was observed only among high‐AS participants, which suggested that high‐AS individuals may be particularly sensitive to alcohol‐induced reductions in their degree of fear and negative thinking in response to the experience of physical arousal sensations. In contrast, dose‐dependent alcohol dampening of self‐reported somatic reactivity was observed among both high‐ and low‐AS participants. We discuss implications of these results for understanding risk for alcohol abuse in high‐AS individuals, as well as directions for future research.
Thirty-two male social drinkers were randomly assigned to one of two expectancy conditions in which they were led to believe that the beverage they consumed contained either vodka and tonic or tonic only. For half of the subjects in each expectancy condition, the beverage actually contained vodka; the others drank only tonic. After their drinks, subjects' heart rates were monitored during a brief social interaction with a female confederate. Self-report and questionnaire measures of social anxiety were taken before and after the interaction. Subjects who believed that they had consumed alcohol showed significantly less increase in heart rate than those who believed that they consumed tonic only, regardless of the actual content of their drinks. There was no effect of alcohol per se. The theoretical implications of these results are briefly discussed.
A growing literature suggests a significant relationship between “anxiety sensitivity” (AS; fear of anxiety symptoms) and alcohol use/abuse. The present study examined the relationship between levels of AS and self-reported rates of weekly alcohol consumption and frequency of “excessive drinking” (i.e., number of times legally intoxicated per year). Subjects were 30 nonalcoholic university women, divided into three AS groups (high, moderate, and low) based upon scores on the Anxiety Sensitivity Index (ASI). High AS women reported consuming significantly more alcoholic beverages on a weekly basis and drinking to excess more times per year than low AS controls. ASI scores were found to be significantly positively correlated with both measures of self-reported alcohol consumption. The results support the hypothesis of a positive relationship between AS levels in young adult women and extent of excessive alcohol use.
Anxiety sensitivity (AS) is the fear of anxiety-related sensations arising from beliefs that these sensations have harmful physical, psychological, or social consequences. AS is measured using the Anxiety Sensitivity Index (ASI), a 16-item self-report questionnaire. Little is known about the origins of AS, although social learning experiences (including sex-role socialization experiences) may be important. The present study examined whether there were gender differences in: (a) the lower- or higher-order factor structure of the ASI; and/or (b) pattern of ASI factor scores. The ASI was completed by 818 university students (290 males; 528 females). Separate principal components analyses on the ASI items of the total sample, males, and females revealed nearly identical lower-order three-factor structures for all groups, with factors pertaining to fears about the anticipated (a) physical, (b) psychological, and (c) social consequences of anxiety. Separate principal components analyses on the lower-order factor scores of the three samples revealed similar unidimensional higher-order solutions for all groups. Gender × AS dimension analyses on ASI lower-order factor scores showed that: females scored higher than males only on the physical concerns factor; females scored higher on the physical concerns factor relative to their scores on the social and psychological concerns factors; and males scored higher on the social and psychological concerns factors relative to their scores on the physical concerns factor. Finally, females scored higher than males on the higher-order factor representing the global AS construct. The present study provides further support for the empirical distinction of the three lower-order dimensions of AS, and additional evidence for the theoretical hierarchical structure of the ASI. Results also suggest that males and females differ on these various AS dimensions in ways consistent with sex role socialization practices.
An accumulating body of evidence suggests that individuals high in anxiety sensitivity (AS; fear of anxiety symptoms) may be at heightened risk for alcohol problems. Our study was designed to validate differences in self-reported drinking motives and contexts between high and low AS individuals using analogue methods. Participants were nonclinical young adults who scored high (n = 26) or low (n = 26) on the Anxiety Sensitivity Index. Participants were exposed to a social affiliative context manipulation where they played the same game, either alone (solitary context) or with two confederates (social context), followed by a mock beverage taste-rating task which provided an unobstrusive measure of ad-lib alcohol consumption. As predicted, high AS-solitary participants consumed significantly more alcohol as compared to high AS-social and low AS-solitary participants. Unexpectedly, high AS-social participants also consumed significantly more nonalcoholic control beverages as compared to high AS-social and low AS-solitary participants. However, only alcoholic beverage consumption was marginally positively correlated with negative affect scores and only for high AS participants. These results provide preliminary validation of previous self-report findings suggesting the use of high ASI scores as a potential marker for a pattern of context-dependent drinking that is associated with problematic alcohol use. We discuss some specific implications of our findings for prevention of the development of drinking problems, and the relevance of laboratory research for advancing behavior therapy in general.
Thesis (M.A.)--University of South Florida, 1989. Includes bibliographical references (leaves 86-92).
Investigated the role of alcohol, expectancy, and cognitive labeling in producing positive emotional changes following moderate alcohol consumption. In a 2–3 factorial design, 96 male normal drinkers (undergraduates) were (a) given either an alcoholic (.45 g ethanol/kg) or a nonalcoholic beverage, (b) instructed that they were receiving either an alcoholic or a nonalcoholic beverage, and (c) either informed or not informed of common physical sensations that result from a moderate dose of alcohol. Ss were then exposed to humorous stimuli, and their laughter and self-reports of mood were measured. Hypotheses based on extensions to alcohol intoxication of the cognitive-attributional components of S. Schachter's (1964) theory of emotion were not supported. Although both instructing Ss that they had received alcohol and actually administering alcohol increased Ss' reports of positive affect, only the beverage content instruction influenced Ss' laughter. Implications for current conceptualizations of the emotional and behavioral effects of alcohol consumption are discussed. (35 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The tension reduction hypothesis has been historically and cross-culturally a predominant explanation of alcohol's effects. However, its validation has been inconsistent. One speculative reason for this inconsistency is a failure to control for preheld alcohol expectancies. Past research may have confounded results due to studying populations mixed regarding their expectations of alcohol's tension reducing effects. Only two studies could be found which have comprehensively attempted to control for tension reduction expectancies, both supporting a modified tension reduction hypothesis which does not offer tension reduction as the only explanation of drinking behaviour. The interaction of pharmacology, expectancy, gender role and situation suggest that tension reduction is of major importance in understanding the drinking of many, but not all, individuals. This is consistent with recent 'metatheories' of alcohol use which emphasize the complexity and multiplicity of alcohol's effects. Future theoretical and clinical implications of the revised tension reduction hypothesis and expectancies are briefly discussed.
Pavlovian conditioning studies with alcohol in humans have been performed exclusively with men subjects. Men demonstrate a placebo response opposite in direction to alcohol, which Newlin (Alcohol Clin Exp Res 9:411-416, 1985) termed an antagonistic placebo response. The current study used normal women subjects given alcohol, placebo, or a soft drink control. Placebo significantly (p less than 0.05) increased heart rate compared to the control condition, and this placebo response was in the same direction as the effect of alcohol. The correlation of heart rate change with reported intoxication was +0.44 in women, when it was negative in men (Newlin DB: Alcohol Clin Exp Res 9:411-416, 1985). These results, when considered in relation to other data concerning individual differences in antagonistic placebo responding, suggest a pattern in which risk for alcoholism is negatively related to placebo responding.
One hundred seventy-nine volunteer male subjects participated in a test of a modified version of the balanced-placebo design at clinically significant B.A.L.s (.081-.105 mg/dl). Half of these subjects were given dose and instructions according to a standard balanced-placebo design; the others received active placebos where appropriate, and instructions tailored to accomodate the mismatch between dose and expectancy. A measure of subjective intoxication was taken after a forty-minute drinking period, and again thirty minutes later. The results showed the modified balanced placebo design to be superior to the standard approach in creating subjective intoxication consistent with instructions and stable over time. An attributional formulation of the results is offered and the modified balanced-placebo design is advanced as an alternative particularly useful for the investigation of dose/expectancy effects at high B.A.L.s.
In this study, we examined the effects of anxiety sensitivity on the response to hyperventilation in college students with and without a history of spontaneous panic attacks. Reiss et al.'s (Behav. Res. Ther. 24, 1-8, 1986) Anxiety Sensitivity Index and Norton et al.'s (Behav. Ther. 17, 239-252, 1986) Panic Attack Questionnaire were used to select Ss. Following five min of voluntary hyperventilation, high anxiety sensitivity Ss reported more anxiety and more hyperventilation sensations than did low anxiety sensitivity Ss. A history of panic was only associated with enhanced responding to hyperventilation in Ss with high anxiety sensitivity; low anxiety sensitivity Ss who had experience with panic were no more responsive than low anxiety sensitivity Ss who had never had a panic attack. These findings suggest that high anxiety sensitivity may be a crucial determinant of panic attacks provoked by biological challenges (e.g. hyperventilation, sodium lactate infusion).
Male alcoholics who (a) experienced panic attacks prior to abusing alcohol, (b) experienced panic attacks subsequent to abusing alcohol, and (c) had not experienced panic attacks were compared on three sets of measures: the Panic Attack Questionnaire, the Restrained Drinking Scale, and the Inventory of Drinking Situations. The results showed that two groups of Ss who experienced panic attacks were more likely than non-panickers to use drugs other than alcohol, began drinking at an earlier age, had a greater proportion of parents with panic and alcohol related problems, had higher drinking restraint scores, and drank in more situations. The Ss who experienced panic attacks prior to abusing alcohol were more likely than the other groups to drink in situations similar to those related to agoraphobic fears. It was postulated that alcoholics who experience panic attacks, especially those who experienced panic attacks prior to abusing alcohol may be using alcohol to reduce anxiety or fear related to panic attacks.
Discusses the variables discovered in animal and human studies that determine the degree to which alcohol reduces anxiety. Physical and social settings have been shown to influence the rate and amount of alcohol consumption and the effects of intoxication. The impact of alcohol varies individually depending on risk factors for alcoholism, self-awareness, Type A behavior patterns, presence of anxiety disorders, tolerance and drinking patterns, and gender. Theoretical mechanisms focus on peripheral vs central nervous system (CNS) mediation, as evidenced in animal studies. Psychosocial theories of alcohol's anxiolytic effects include mediation through cognitive change and conditioning in avoidance behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A distinction is proposed between anxiety (frequency of symptom occurrence) and anxiety sensitivity (beliefs that anxiety experiences have negative implications). In Study 1, a newly-constructed Anxiety Sensitivity Index (ASI) was shown to have sound psychometric properties for each of two samples of college students. The important finding was that people who tend to endorse one negative implication for anxiety also tend to endorse other negative implications. In Study 2, the ASI was found to be especially associated with agoraphobia and generally associated with anxiety disorders. In Study 3, the ASI explained variance on the Fear Survey Schedule—II that was not explained by either the Taylor Manifest Anxiety Scale or a reliable Anxiety Frequency Checklist. In predicting the development of fears, and possibly other anxiety disorders, it may be more important to know what the person thinks will happen as a result of becoming anxious than how often the person actually experiences anxiety. Implications are discussed for competing views of the ‘fear of fear’.
It is argued that fear and avoidance can co-vary, vary inversely or vary independently. The consequences of this statement for therapeutic theory and practice are discussed. A critical comment on two-factor theory is followed by a discussion of two alternative theories, one proposed by Gray and the other by Herrnstein. Definitions of concordance, discordance, synchrony and desynchrony are offered.
The authors report an abbreviated version of the Michigan Alcoholism Screening Test (MAST). They hypothesized, on the basis of previously published data, that scores based on ten of the questions of the MAST would be as effective in discriminating between alcoholics and nonalcoholics as scores based on all 25 questions. The responses of 60 alcoholic and 62 nonalcoholic psychiatric patients supported their hypothesis.
The Sensation Scale was originally constructed to measure the subjective experience of physiological changes following alcohol consumption. Reduction of the original scale of 31 variables on the basis of face validity resulted in six ‘factors’ comprising 26 variables and one ‘other’ factor. These sortings are shown to have good interrater reliability. Furthermore, evidence is presented from two experiments that five of the six factors discriminated between nonalcoholic male subjects who drank either a beverage containing a moderate dose of alcohol or a nonalcoholic beverage.