Inter-rater and test-retest reliability of the Revised Diagnostic Interview for Borderlines

The baseline inter-rater reliability, test-retest reliability, follow-up inter-rater reliability, and follow-up longitudinal reliability (interrater reliability between generations of raters) of borderline symptoms and the diagnosis of borderline personality disorder (BPD) were assessed using the Revised Diagnostic Interview for Borderlines (DIB-R). Excellent kappa s (> .75) were found in each of these reliability substudies for the diagnosis of BPD itself. Excellent kappa s were also found in each of the three inter-rater reliability substudies for the vast majority of borderline symptoms assessed by the DIB-R. Test-retest reliability for these symptoms was somewhat lower but still very good. More specifically, one-third of the BPD symptoms assessed had a kappa in the excellent range and the remaining two-thirds had a kappa in the fair-good range (.57-.73). The dimensional reliability of BPD symptom areas was somewhat higher than for categorical measures of the subsyndromal phenomenology of BPD. More specifically, all five dimensional measures of borderline psychopathology had intraclass correlation coefficients in the excellent range for all four reliability substudies. Taken together, the results of this study suggest that both the borderline diagnosis and the symptoms of BPD can be diagnosed reliably when using the DIB-R. They also suggest that excellent reliability, once achieved, can be maintained over time for both the syndromal and subsyndromal phenomenology of BPD.     

A Multimodal Study of Childhood Trauma and Distress Tolerance in Young Adulthood

Individuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.     

Validation of Self-Report Measures of Emotional and Physical Distress Tolerance

The Distress Tolerance Scale (DTS) and Discomfort Intolerance Scale (DIS) are self-report measures developed for the assessment of emotional and physical distress tolerance, respectively. However, little evidence exists for their construct and specifically criterion-related validity. The current study examined the associations of these self-report measures with lab-based assessments of perceived emotional tolerance and physical discomfort tolerance. Undergraduate participants (N?=?166) were administered four film clips intended to induce sadness, disgust, fear, and anger, and a handgrip persistence task intended to elicit physical discomfort. The DTS, but not the DIS, was significantly associated with self-reported emotional tolerance and perceived threat associated with each film after controlling for emotional intensity. Among DTS subscales, the absorption subscale was the only subscale incrementally predictive of negative perceptions of the sad film, the appraisal subscale was incrementally predictive of negative perceptions of the other three films, and little support for the incremental validity of the tolerance and regulation subscales was found. The DTS also incrementally predicted tolerance and perceived threat of film-elicited emotions across films after controlling for anxiety sensitivity. The DIS was only marginally predictive of handgrip task persistence and was unrelated to emotional film perceptions. Overall, these findings uniquely add to the empirical literature on the construct and criterion-related validity of the DTS and DIS.     

Anxiety Sensitivity Moderates Relations Among Tobacco Smoking,Panic Attack Symptoms,and Bodily Complaints in Adolescents

The present study evaluated associations among smoking and anxiety sensitivity (fear of anxiety and anxiety related sensations) in predicting panic attack symptomatology, somatic complaints, and depressive symptomatology in a community sample of adolescents (ages 12 to 17 years; N=206). As predicted, the combination of high levels of anxiety sensitivity and being a current smoker predicted panic symptomatology and somatic complaints, but not depressive symptomatology. These findings suggest anxiety sensitivity may moderate the relation between smoking and prototypical panic psychopathology variables (panic attacks and somatic complaints) even after controlling for gender and negative affectivity, and that these associations are specific to panic-relevant processes. The primary implication of the study findings is that there may be segments of the adolescent population who are at relatively greater risk for panic-related problems by virtue of individual differences in AS and smoking status.

Distress Tolerance Scale: A Confirmatory Factor Analysis Among Daily Cigarette Smokers

The present investigation evaluated the factor structure of the Distress Tolerance Scale (DTS; Simons and Gaher 2005) among a sample of 173 (54.9% males) daily cigarette smokers (M = 16.64 cigarettes per day, SD = 7.83). Comparison of a single higher-order model and a hierarchical multidimensional model was conducted using confirmatory factor analyses (CFA). In addition, evaluation of the internal consistency and convergent and discriminant validity of the better-fitting model was completed. CFA of the DTS indicated a single second-order factor of distress tolerance, and four lower-order factors including Tolerance, Appraisal, Absorption, and Regulation; each factor demonstrated acceptable levels of internal consistency. In addition, the DTS displayed good convergent and discriminant validity with theoretically relevant smoking and affect variables. Results are discussed in terms of explicating the latent structure of distress tolerance, as measured by the DTS, within the context of smoking research.     

Single-session anxiety sensitivity reduction program for trauma-exposed adults: a case series documenting feasibility and initial efficacy

The present case series examined a single-session, cognitive-behavioral anxiety sensitivity (AS) reduction program among five trauma-exposed adults. Participants (age range=19-37 years) reported significantly elevated levels of AS at baseline, a history of posttraumatic stress disorder Criterion A trauma exposure, and no current Axis I psychopathology. The outcomes of the preventive intervention were examined with regard to 3-month postintervention changes in AS, posttraumatic stress, panic attack frequency and severity, negative affect levels, and behavioral functioning and impairment. Results demonstrated decreases in each of the studied outcomes over the examined time period. This preliminary yet uncontrolled data provides empirical evidence of the feasibility and support for the utilization of a brief AS reduction intervention program to target anxiety-related vulnerability among trauma-exposed adults.     

Posttraumatic stress and panic psychopathology: clinical import, research advances, and future directions--introduction to the special issue

There has been a relative dearth of empirical attention focused on the study of the co-occurrence of posttraumatic stress and panic psychopathology. Since these conditions represent two prevalent and impairing psychiatric conditions, the study of their diagnostic and phenomenological comorbidity is clinically meaningful and theoretically warranted. The articles in this series discuss the possible cognitive-affective mechanisms relevant to both conditions and elucidate innovations in applicable clinical intervention approaches. Thus, the overarching purpose of this series is to underscore key empirical questions, to showcase emerging research, and to stimulate further scientific inquiry into the co-occurrence of posttraumatic stress and panic psychopathology.     

An Evaluation of the Relation Between Distress Tolerance and Posttraumatic Stress within a Trauma-Exposed Sample

The present investigation examined the incremental associations between distress tolerance, or the perceived capacity to tolerate emotional distress, and global posttraumatic stress symptom severity as well as symptom cluster severity, beyond the variance accounted for by number of trauma exposure types and negative affectivity. The sample consisted of 140 adults (72 women; M _age = 25.9, SD = 11.1) who endorsed exposure to traumatic life events, as defined by posttraumatic stress disorder diagnostic criterion A (American Psychiatric Association 2000). Participants did not meet diagnostic criteria for current axis I psychopathology. Distress tolerance demonstrated significant incremental associations with global posttraumatic stress symptom severity (p < .01) as well as re-experiencing (p < .05), avoidance (p = .05), and hyperarousal (p < .001) symptom cluster severity. Given the cross-sectional study design, causation cannot be inferred. Theoretical implications and future directions for better understanding associations between distress tolerance and posttraumatic stress are discussed.     

Sixteen-item Anxiety Sensitivity Index: confirmatory factor analytic evidence, internal consistency, and construct validity in a young adult sample from the Netherlands

The present investigation examined the factor structure, internal consistency, and construct validity of the 16-item Anxiety Sensitivity Index (ASI; Reiss Peterson, Gursky, & McNally 1986) in a young adult sample (n = 420) from the Netherlands. Confirmatory factor analysis was used to comparatively evaluate two-factor, three-factor, and four-factor models of the anxiety sensitivity construct. Support was found for a hierarchical structure of anxiety sensitivity, with one global higher-order factor and four lower-order factors. Internal consistency for the global and lower-order factors of the 16-item ASI was adequate. Convergent and discriminant associations between the 16-item ASI and general mood and panic-specific variables were consistent with anxiety sensitivity theory. In addition, incremental validity of the anxiety sensitivity construct was established, relative to negative affectivity, for unexpected panic attacks and agoraphobic avoidance.     

A Prospective Investigation of Changes in Avoidant and Active Coping and Posttraumatic Stress Disorder Symptoms among Military Veteran

The present investigation utilized a prospective design to investigate associations between changes in self-reported avoidant and active coping occurring during residential treatment for posttraumatic stress disorder (PTSD) and PTSD symptom severity at treatment discharge. Participants were 636 military Veteran patients (91.4?% male; M _age?=?51.7?years) admitted to a Veterans Affairs (VA) residential rehabilitation program for PTSD, between 2000 and 2008. Results indicated that increases in avoidant coping and decreases in active coping from treatment intake to discharge were simultaneously and incrementally predictive of total PTSD symptom severity at treatment discharge, after accounting for PTSD symptom severity at treatment intake. These findings hold particular relevance for treatment-seeking populations with severe PTSD and researchers and clinicians attempting to understand and treat these populations.