Factor structure and initial validation of a brief measure of perceived emotional and physical distress tolerance in post-9/11 US Veterans

Distress tolerance (i.e., perceived or actual capacity to tolerate aversive internal states) has received considerable research attention as a transdiagnostic risk-factor underlying the development and maintenance of psychopathology. Lower levels of emotional distress tolerance have been linked to psychopathology (e.g. Posttraumatic Stress Disorder) within Military populations; however, the association of physical distress tolerance to psychopathology in this population has been under-researched. This research gap may be due in part to a paucity of comprehensive, temporally stable and brief measures of distress tolerance that have been validated within Military populations, which may hinder further examination and refinement of the construct. Addressing this problem, the current study evaluates the psychometric properties of a novel and brief measure of emotional and physical distress tolerance in a sample of United States post-9/11 Veterans. Participants were 307 Veterans (M_age = 38.9, 67.7% male) who completed the 10-item Distress Tolerance Inventory at baseline and annual follow-up. Exploratory structural equation modeling was used to examine the optimal latent factor structure and longitudinal invariance of the DTI measurement model, along with correlational analyses to examine the convergent properties of the DTI subscales. The DTI reflected a longitudinally invariant two-factor structure (emotional and physical distress tolerance), with excellent internal consistency and preliminary evidence of convergent validity. Thus, the DTI represents a brief, reliable and temporally stable measure of physical and emotional distress tolerance.     

Prevalence of Smoking in Anxiety Disorders Uncomplicated by Comorbid Alcohol or Substance Abuse

This study examined the point prevalence of smoking in patients with anxiety disorders who do not have comorbid alcohol or substance abuse or dependence (ASAD). In a retrospective chart review, the smoking status of 581 patients with anxiety disorders was assessed. Patients, ages 18–65, were seeking treatment for anxiety disorders at an outpatient clinic that specialized in anxiety and related disorders. All participants were interviewed using the Anxiety Disorders Interview Schedule—IV, during which their smoking status was assessed. The prevalence of smoking across all anxiety disorders was 14.8%, which is much lower than found in the general population (23.3%; CDC, 2002) and even lower than previous estimates in individuals with comorbid anxiety and ASAD. Individuals with panic disorder and generalized anxiety disorder had the highest prevalence of smoking, although these rates were still considerably lower than those found in previous studies of smokers with anxiety disorders. Reasons for lower prevalence estimates are discussed.     

Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships

Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. The authors critically examined the relationships among anxiety, anxiety disorders, tobacco use, and nicotine dependence and reviewed the existing empirical literature. Future research is needed to better understand the interrelationships among these variables, including predictors, moderators, and mechanisms of action. Increased knowledge in these areas should inform prevention efforts as well as the development and improvement of smoking cessation programs for those with anxiety and other psychiatric disorders.     

The effects of venlafaxine and cognitive behavioral therapy alone and combined in the treatment of co-morbid alcohol use-anxiety disorders

The effects of the antidepressant venlafaxine (VEN-225 mg daily) and transdiagnostic cognitive behavioral treatment (CBT) alone and in combination on alcohol intake in subjects with co-morbid alcohol use disorders (AUDs) and anxiety disorders were compared. Drinking outcomes and anxiety were assessed for 81 subjects treated for 11 weeks with one of 4 conditions: 1) VEN–CBT, 2) VEN-Progressive Muscle Relaxation therapy (PMR), 3) Placebo (PLC)-CBT and 4) a comparison group of PLC-PMR. For subjects who reported taking at least one dose of study medication, the Time × Group interaction was significant for percent days of heavy drinking and drinks consumed per day. For the measure of percent days heavy drinking, the paired comparison of PLC-CBT versus PLC-PMR group indicated that the PLC-CBT group had greater drinking reductions, whereas other groups were not superior to the comparison group. In Week 11, the proportion of subjects in the PLC-CBT group that had a 50% reduction from baseline in percent days heavy drinking was significantly greater than those in the comparison group. Of the 3 “active treatment” groups only the PLC-CBT group had significantly decreased heavy drinking when contrasted to the comparison group. This finding suggests that the transdiagnostic CBT approach of Barlow and colleagues may have value in the management of heavy drinking in individuals with co-morbid alcoholism and anxiety.     

Transdermal nicotine during cue reactivity in adult smokers with and without anxiety disorders

Transdermal nicotine almost doubles tobacco cessation rates; however, little is known about what happens to smokers during the quit process when they are wearing the nicotine patch and are confronted with high-risk smoking triggers. This is particularly important for smokers with psychological disorders who disproportionately represent today's smokers and have more trouble quitting. Using a mixed between- and within-subjects design, smokers with anxiety disorders (n = 61) and smokers without any current Axis I disorders (n = 38) received transdermal nicotine (21 mg) or a placebo patch over two assessment days separated by 48 hr. Urge to smoke was evaluated during a 5-hr patch absorption period (reflecting general smoking deprivation) and during imaginal exposure to theoretically high-risk triggers containing smoking cues, anxiety cues, both, or neutral cues. No differences were observed between smokers with and without anxiety disorders. Significant Patch × Time and Patch × Cue Content interactions were found. Both patch conditions experienced an increase in urge during the deprivation period, but postabsorption urge was significantly higher in the placebo condition, suggesting that transdermal nicotine attenuated the degree to which urge to smoke increased over time. During the cue reactivity trials, when participants received the nicotine patch, they experienced significantly lower urge in response to both smoking-only and neutral cues, but not when anxiety cues were present (alone or in combination with smoking cues). These data suggest that transdermal nicotine alleviates urge only under certain circumstances and that adjunctive interventions are likely necessary to address smoking urges in response to spikes in distress among smokers trying to quit. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The dimensionality of counterproductivity: Are all counterproductive behaviors created equal?

Most studies of counterproductive work behavior (CWB) assess it as one or two overall dimensions that might obscure relationships of potential antecedents with more specific forms of behavior. A finer-grained analysis of the relationship between counterproductive work behavior and antecedents was conducted with the five-subscales (abuse toward others, production deviance, sabotage, theft, and withdrawal) taken from the 45-item Counterproductive Work Behavior Checklist, a measure that has been used in a number of prior studies. Described is the rationale for each of the five dimensions, which have been discussed individually in the literature. Data from three combined studies provide evidence for differential relationships with potential antecedents that suggest the use of more specific subscales to assess CWB. Most notably, abuse and sabotage were most strongly related to anger and stress, theft was unrelated to emotion, and withdrawal was associated with boredom and being upset. Finally, the distinct forms of CWB may suggest distinct underlying dynamics, that vary in their balance of hostile and instrumental motivational systems.     

Exposure to negative emotional cues and alcohol cue reactivity with alcoholics: a preliminary investigation

Fifty-one male and female inpatient alcoholics received cue exposure treatment involving in vivo exposure to alcohol cues and imaginal exposure to individualized high-risk drinking situations involving negative emotional cues. At post-test, self-report measures of urge to drink alcohol and negative emotional states were obtained during an alcohol cue reactivity assessment. Contrary to our hypothesis, greater exposure to negative emotional cues during treatment was associated with greater urge and negative emotional responses at post-test. In addition, greater duration of exposure to negative emotional cues predicted greater attention to alcohol-related stimuli and thoughts about drinking during the post-test. Implications for future research in this area include extending the duration of exposure to negative emotional cues in order to establish the optimal exposure durations within which a majority of individuals achieve clinically significant reductions in their urge to drink alcohol.