Publications by authors named "Anka A Vujanovic"

122 Publications

Posttraumatic stress symptom clusters differentially predict late positive potential to cocaine imagery cues in trauma-exposed adults with cocaine use disorder.

Drug Alcohol Depend 2021 Jul 28;227:108929. Epub 2021 Jul 28.

Department of Psychology, University of Houston, Houston, TX, United States.

Background: While studies have investigated the effects of posttraumatic stress disorder (PTSD) symptoms on substance use, information on these associations in the context of drug cue reactivity is lacking, which can provide meaningful information about risk for relapse. The current study assessed the associations between PTSD symptom clusters and reactivity to cues in trauma-exposed adults with cocaine use disorder.

Methods: We recorded electroencephalogram on 52 trauma-exposed participants (M = 51.3; SD = 7.0; 15.4 % women) diagnosed with cocaine use disorder while they viewed pleasant (i.e., erotic, romantic, sweet foods), unpleasant (i.e., mutilations, violence, accidents), neutral, and cocaine-related images. Reactivity was measured with the late positive potential (LPP), an indicator of motivational relevance. It was hypothesized that individuals with greater PTSD avoidance and negative alterations in cognition and mood (NACM) symptoms, as determined by the PTSD Checklist for DSM-5 (PCL-5), would have higher LPPs to cocaine-related images, indicating greater cue reactivity.

Results: Linear mixed modeling indicated that higher NACM symptomatology was associated with higher LPPs to cocaine cues and higher arousal/reactivity was associated with lower LPPs to cocaine cues.

Conclusions: These results highlight the potential clinical utility of the LPP in assessing drug cue reactivity in trauma-exposed adults with substance use disorder.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108929DOI Listing
July 2021

Posttraumatic stress symptom clusters differentially predict late positive potential to cocaine imagery cues in trauma-exposed adults with cocaine use disorder.

Drug Alcohol Depend 2021 Jul 28;227:108929. Epub 2021 Jul 28.

Department of Psychology, University of Houston, Houston, TX, United States.

Background: While studies have investigated the effects of posttraumatic stress disorder (PTSD) symptoms on substance use, information on these associations in the context of drug cue reactivity is lacking, which can provide meaningful information about risk for relapse. The current study assessed the associations between PTSD symptom clusters and reactivity to cues in trauma-exposed adults with cocaine use disorder.

Methods: We recorded electroencephalogram on 52 trauma-exposed participants (M = 51.3; SD = 7.0; 15.4 % women) diagnosed with cocaine use disorder while they viewed pleasant (i.e., erotic, romantic, sweet foods), unpleasant (i.e., mutilations, violence, accidents), neutral, and cocaine-related images. Reactivity was measured with the late positive potential (LPP), an indicator of motivational relevance. It was hypothesized that individuals with greater PTSD avoidance and negative alterations in cognition and mood (NACM) symptoms, as determined by the PTSD Checklist for DSM-5 (PCL-5), would have higher LPPs to cocaine-related images, indicating greater cue reactivity.

Results: Linear mixed modeling indicated that higher NACM symptomatology was associated with higher LPPs to cocaine cues and higher arousal/reactivity was associated with lower LPPs to cocaine cues.

Conclusions: These results highlight the potential clinical utility of the LPP in assessing drug cue reactivity in trauma-exposed adults with substance use disorder.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108929DOI Listing
July 2021

Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis.

Cogn Behav Ther 2021 Jul 19:1-30. Epub 2021 Jul 19.

Department of Psychology, University of Houston, Houston, Texas, USA.

The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants ( =29.96,  = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude  = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.
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http://dx.doi.org/10.1080/16506073.2021.1942541DOI Listing
July 2021

Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis.

Cogn Behav Ther 2021 Jul 19:1-30. Epub 2021 Jul 19.

Department of Psychology, University of Houston, Houston, Texas, USA.

The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants ( =29.96,  = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude  = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.
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http://dx.doi.org/10.1080/16506073.2021.1942541DOI Listing
July 2021

Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters.

Behav Modif 2021 May 19:1454455211016819. Epub 2021 May 19.

University of Houston, Houston, TX, USA.

Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters ( = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood ('s = .028-.042; 's < .01); AS social concerns was incrementally associated with PTSD avoidance ( = .03,  < .01). Implications for firefighter-informed, evidence-based interventions are discussed.
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http://dx.doi.org/10.1177/01454455211016819DOI Listing
May 2021

Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters.

Behav Modif 2021 May 19:1454455211016819. Epub 2021 May 19.

University of Houston, Houston, TX, USA.

Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters ( = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood ('s = .028-.042; 's < .01); AS social concerns was incrementally associated with PTSD avoidance ( = .03,  < .01). Implications for firefighter-informed, evidence-based interventions are discussed.
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http://dx.doi.org/10.1177/01454455211016819DOI Listing
May 2021

Thwarted Belongingness and PTSD Symptom Severity among Firefighters: The Role of Emotion Regulation Difficulties.

Behav Modif 2021 Mar 16:1454455211002105. Epub 2021 Mar 16.

University of Houston, TX, USA.

The present investigation examined the associations among thwarted belongingness (TB), emotion regulation difficulties (ERD), and posttraumatic stress disorder (PTSD) symptom severity among firefighters. First, the associations of TB and ERD with PTSD symptom severity were evaluated. Second, the indirect effect of TB on PTSD symptom severity through ERD was examined. The sample included 246 trauma-exposed firefighters ( age = 40.21,  = 9.93, 93.1% male) who completed an online questionnaire battery. Results demonstrate significant, positive associations among TB, ERD, and PTSD symptom severity; and an indirect effect of TB on PTSD symptom severity through heightened ERD (β = 0.17; CI [0.08, 0.29]). Alternate indirect effect models were also significant, underscoring the potentially bidirectional associations of these variables. These findings suggest that there is merit in investigating the role of interpersonal factors and ERD among firefighter populations to better understand PTSD symptomatology. Clinical and empirical implications are discussed.
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http://dx.doi.org/10.1177/01454455211002105DOI Listing
March 2021

Exploring the impact of the COVID-19 pandemic on the mental health of first responders.

Cogn Behav Ther 2021 May-Jul;50(4):320-335. Epub 2021 Feb 17.

Department of Psychology, University of Houston, Houston, TX, USA.

The present investigation evaluated the preliminary impact of COVID-19 exposure on first responder mental health. Data were collected between June and August 2020. The sample was comprised of 189 first responders ( = 47.58, = 10.93; 21% female), recruited nationally, who completed an online survey. Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel (vs. non-EMS) in career (vs. volunteer) roles. COVID-19-exposed first responders reported higher alcohol use severity; no other between-group differences were noted. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression; only COVID-19-related worry was associated with alcohol use severity. Among the subset of first responders ( = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity. Covariates included gender, trauma load, years as a first responder, and COVID-19 exposure. Clinical and policy implications as well as future directions will be discussed.
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http://dx.doi.org/10.1080/16506073.2021.1874506DOI Listing
June 2021

Mindful Attention and Eating Expectancies among College Students with Obesity and a History of Trauma Exposure.

Mindfulness (N Y) 2020 Sep 7;11(9):2113-2120. Epub 2020 Jul 7.

Department of Psychology, University of Houston, Houston, United States.

Objectives: Trauma exposure and obesity are highly prevalent among college students and both are associated with disordered eating. There is a need to understand psychological factors that may be related to maladaptive eating behavior among college students with obesity and a history of trauma exposure.

Methods: Participants included 139 college students with obesity (defined as a BMI ≥ 30) and a history of trauma exposure (76.3% females; = 25.4 years, = 8.07). The current study conducted three separate two-step hierarchical regressions examining mindful attention, and its relation to eating expectancies (expectancies of eating to help manage negative affect, expectancies of eating to alleviate boredom, and expectancies of eating to lead to feeling out of control).

Results: Results indicated that lower levels of mindful attention were related to greater levels of expectancies of eating to help manage negative affect ( = -4.16, = 1.08, = .023, = -7.72, -0.60, = .04), expectancies of eating to alleviate boredom ( = -1.09, = 0.39, = .006, = -1.86, -0.32, = .06), and expectancies of eating to lead to feeling out of control ( = -1.62, = 0.40, < .001, = -2.41, -0.83, = .11). Results were observed over, and above variance accounted for by sex (assigned at birth), body mass index (BMI), and posttraumatic stress disorder (PTSD) symptom severity.

Conclusions: Overall, the results from the present investigation suggest the potential importance and need for future research in the role of mindful attention in relation to several distinct eating expectancies associated with maladaptive eating.
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http://dx.doi.org/10.1007/s12671-020-01419-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880149PMC
September 2020

Mindful Attention and Eating Expectancies among College Students with Obesity and a History of Trauma Exposure.

Mindfulness (N Y) 2020 Sep 7;11(9):2113-2120. Epub 2020 Jul 7.

Department of Psychology, University of Houston, Houston, United States.

Objectives: Trauma exposure and obesity are highly prevalent among college students and both are associated with disordered eating. There is a need to understand psychological factors that may be related to maladaptive eating behavior among college students with obesity and a history of trauma exposure.

Methods: Participants included 139 college students with obesity (defined as a BMI ≥ 30) and a history of trauma exposure (76.3% females; = 25.4 years, = 8.07). The current study conducted three separate two-step hierarchical regressions examining mindful attention, and its relation to eating expectancies (expectancies of eating to help manage negative affect, expectancies of eating to alleviate boredom, and expectancies of eating to lead to feeling out of control).

Results: Results indicated that lower levels of mindful attention were related to greater levels of expectancies of eating to help manage negative affect ( = -4.16, = 1.08, = .023, = -7.72, -0.60, = .04), expectancies of eating to alleviate boredom ( = -1.09, = 0.39, = .006, = -1.86, -0.32, = .06), and expectancies of eating to lead to feeling out of control ( = -1.62, = 0.40, < .001, = -2.41, -0.83, = .11). Results were observed over, and above variance accounted for by sex (assigned at birth), body mass index (BMI), and posttraumatic stress disorder (PTSD) symptom severity.

Conclusions: Overall, the results from the present investigation suggest the potential importance and need for future research in the role of mindful attention in relation to several distinct eating expectancies associated with maladaptive eating.
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http://dx.doi.org/10.1007/s12671-020-01419-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880149PMC
September 2020

Examining Transdiagnostic Factors among Firefighters in Relation to Trauma Exposure, Probable PTSD, and Probable Alcohol Use Disorder.

J Dual Diagn 2021 Jan-Mar;17(1):52-63. Epub 2020 Dec 14.

Department of Psychology, University of Houston, Houston, TX, USA.

Objective: Firefighters represent a distinct group of first responders that are at heightened risk of developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Assessing the role of transdiagnostic factors that underlie PTSD-AUD associations can inform specialized interventions among this population. This study included urban firefighters ( = 657) with probable PTSD-AUD ( = 27), probable PTSD-alone ( = 35), probable AUD-alone ( = 125), and trauma-exposure-only ( = 470). All firefighters completed a self-report, online questionnaire battery. Between group differences in anxiety sensitivity (AS), distress tolerance (DT), mindfulness, and emotional regulation difficulties (ERD) were assessed. It was hypothesized that firefighters with probable PTSD-AUD would endorse elevated AS and ERD, and reduced DT and mindfulness in comparison to all other diagnostic groups. Relationship status was included as a covariate in all comparisons. Firefighters with probable PTSD-AUD endorsed elevated AS and ERD, and reduced DT and mindfulness in comparison to firefighters with trauma-exposure-only and probable AUD-alone. Firefighters with probable PTSD-AUD and probable PTSD-alone did not significantly differ. Given these findings, this line of inquiry has great potential to inform specialized, evidence-based mental health programming among firefighter populations, who represent a unique population susceptible to trauma-exposure, PTSD symptomology, and problematic alcohol use.
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http://dx.doi.org/10.1080/15504263.2020.1854411DOI Listing
December 2020

Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters.

J Psychosom Res 2020 12 6;139:110269. Epub 2020 Oct 6.

Department of Psychology, University of Houston, Houston, TX, United States of America. Electronic address:

Background: Firefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters.

Methods: Participants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items-experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years-were considered high in cardiovascular risk.

Results: A structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p < .01) and depression symptoms (β = 0.32, p < .01); lower DT was associated with greater PTSD (β = -0.18, p < .01) and depression symptoms (β = -0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p < .01]; low cardiovascular risk group: β = 0.33, p < .01).

Conclusions: High cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.
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http://dx.doi.org/10.1016/j.jpsychores.2020.110269DOI Listing
December 2020

Objective analysis of language use in cognitive-behavioral therapy: associations with symptom change in adults with co-occurring substance use disorders and posttraumatic stress.

Cogn Behav Ther 2021 03 6;50(2):89-103. Epub 2020 Oct 6.

Department of Psychology, University of Houston , Houston, TX, USA.

Substance use disorders (SUD) commonly co-occur with posttraumatic stress disorder (PTSD) symptoms, and the comorbidity is prevalent and difficult-to-treat. Few studies have objectively analyzed language use in psychotherapy as a predictor of treatment outcomes. We conducted a secondary analysis of patient language use during cognitive-behavioral therapy (CBT) in a randomized clinical trial, comparing a novel, integrated CBT for PTSD/SUD with standard CBT for SUD. Participants included 37 treatment-seeking, predominantly African-American adults with SUD and at least four symptoms of PTSD. We analyzed transcripts of a single, matched session across both treatment conditions, using the Linguistic Inquiry and Word Count (LIWC) program. The program measures language use across multiple categories. Compared to standard CBT for SUD, patients in the novel, integrated CBT for PTSD/SUD used more negative emotion words, partially consistent with our hypothesis, but less positive emotion words. Further, exploratory analyses indicated an association between usage of cognitive processing words and clinician-observed reduction in PTSD symptoms, regardless of treatment condition. Our results suggest that language use during therapy may provide a window into mechanisms active in therapy.
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http://dx.doi.org/10.1080/16506073.2020.1819865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897212PMC
March 2021

Alcohol use problems and opioid misuse and dependence among adults with chronic pain: The role of distress tolerance.

Psychol Addict Behav 2021 Feb 4;35(1):42-51. Epub 2020 May 4.

Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston.

Alcohol use has been associated with opioid misuse and dependence among adults with chronic pain. Yet, mechanisms underlying the relation between alcohol use problems and opioid misuse and dependence have yet to be fully explored among this population. Distress tolerance, reflecting the perceived ability to withstand negative emotional states, has demonstrated independent associations with alcohol use problems and opioid misuse, but these associations have not been explored among persons with chronic pain. The present study examined the moderating role of distress tolerance in terms of the association between alcohol use problems with opioid misuse and severity of opioid dependence. Participants included 424 adults (74.1% female; = 38.3, = 11.1) reporting current chronic pain and opioid medication use. Results indicated that alcohol use problems were significantly associated with current opioid misuse ( = 0.54, < .001) and severity of opioid dependence ( = 0.08, = .002) only for those with lower distress tolerance. These findings suggest that among individuals with chronic pain, the association between alcohol use problems and opioid misuse as well as opioid dependence severity is amplified among those with lower perceived distress tolerance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/adb0000587DOI Listing
February 2021

Pain intensity, alcohol use motives, and alcohol use among firefighters: The moderating role of pain-related anxiety.

Addict Behav 2020 08 28;107:106415. Epub 2020 Mar 28.

University of Houston, Department of Psychology, United States. Electronic address:

Firefighters are an understudied population that reports high rates of alcohol use and hazardous drinking. Pain, which is also commonly experienced by firefighters, may be associated with alcohol use and alcohol use motives, as research among the general population suggests that pain is associated with coping-oriented drinking. Pain-related anxiety, reflecting a tendency to respond to pain with anxiety or fear, may link pain to coping-oriented drinking among firefighters. Therefore, the current study examined the moderating role of pain-related anxiety on the association between pain intensity and alcohol use motives as well as alcohol use severity. The sample was comprised of 189 (M = 40.33, SD = 9.97, 89.9% male) firefighters. Results from the current study supported a significant moderation effect of pain-related anxiety on the association between pain intensity and alcohol use coping motives, whereby the association between pain intensity and coping motives was stronger for those with high compared to low pain-related anxiety. No significant moderation effects were documented for social, enhancement, or conformity motives; and no significant moderation effect was found for alcohol use severity. These results highlighted the potential importance of pain intensity and pain-related anxiety in coping-oriented alcohol use among firefighters.
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http://dx.doi.org/10.1016/j.addbeh.2020.106415DOI Listing
August 2020

Posttraumatic stress, alcohol use severity, and alcohol use motives among firefighters: The role of anxiety sensitivity.

Addict Behav 2020 07 12;106:106353. Epub 2020 Feb 12.

University of Houston, Department of Psychology, Houston, TX, United States. Electronic address:

Introduction: Firefighters are vulnerable to developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Anxiety sensitivity (AS) is a cognitive-affective mechanism with clinical relevance to both PTSD and AUD. The current study examined the potential role of AS in the association of PTSD symptomatology with alcohol use severity and alcohol use motives among a large sample of firefighters. Heightened PTSD and high AS were expected to be associated with alcohol use severity and coping-oriented alcohol use motives. Heightened PTSD symptomatology was expected to be indirectly associated with alcohol use severity and coping motives through high AS. Covariates included number of years in the fire service and the number of traumatic event types endorsed.

Methods: Participants included 652 urban firefighters (93.3% male; M = 38.7, SD = 8.57). Firefighters completed an online questionnaire battery.

Results: PTSD symptomatology was positively associated with alcohol use and coping motives. AS was positively associated with alcohol use coping motives but not alcohol use severity. AS partially explained the association between PTSD symptomatology and coping, conformity, and social motives, but did not significantly account for the relationship between PTSD symptom severity and enhancement motives or alcohol use severity.

Conclusions: Among firefighters, the association between PTSD and alcohol use coping, conformity, and social motives is partially accounted for by AS. Clinical and research implications are discussed.
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http://dx.doi.org/10.1016/j.addbeh.2020.106353DOI Listing
July 2020

Anxiety sensitivity and opioid misuse and dependence among trauma-exposed adults with chronic pain.

J Behav Med 2020 04 18;43(2):174-184. Epub 2020 Feb 18.

Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, Department of Psychology, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, TX, 77204-5502, USA.

It is unclear if anxiety sensitivity may serve as mechanism underlying the relation between posttraumatic stress symptom severity and opioid misuse and dependence among trauma-exposed persons with chronic pain. Therefore, the current study evaluated the explanatory role of anxiety sensitivity in the relations between posttraumatic stress symptom severity and opioid misuse and dependence. Participants included 294 trauma-exposed adults with chronic pain (71.4% female, M = 37.79 years, SD = 10.85, M = 7.32/10) that reported current moderate to severe chronic pain and prescription opioid use. Participants were recruited via an online national survey in the United States of America. There were statistically significant indirect effects of posttraumatic stress symptom severity via anxiety sensitivity in relation to opioid misuse and dependence. The indirect effects of the reverse models for opioid misuse and dependence also were significant and suggest the potential for bi-directional relations; however, the magnitude of the effect was smaller in the tests of specificity than in the original models. The present findings provide initial empirical evidence that greater posttraumatic stress symptom severity is related to anxiety sensitivity, which in turn, is associated with increased opioid misuse and dependence among trauma-exposed individuals with chronic pain.
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http://dx.doi.org/10.1007/s10865-020-00142-5DOI Listing
April 2020

Mindfulness as a predictor of cognitive-behavioral therapy outcomes in inner-city adults with posttraumatic stress and substance dependence.

Addict Behav 2020 05 30;104:106283. Epub 2019 Dec 30.

University of Texas Health Science Center at Houston, United States.

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent and difficult-to-treat. Mindfulness, defined as nonjudgmental attention to and awareness of present-moment experiences, represents a targetable mechanism with potential to predict and improve treatment outcomes for PTSD/SUD populations. We hypothesized that greater self-reported mindfulness at baseline (pre-treatment) would predict (a) lower end-of-treatment PTSD severity and (b) greater longest sustained abstinence during a 12-week cognitive-behavioral treatment program. Participants included 53 inner-city adults meeting at least four current symptoms of DSM-5 PTSD and current (DSM-IV) substance dependence (51% women; 75.5% African American; Mage = 45.42, SD = 9.99). Hierarchical regression analysis results indicated that higher levels of baseline mindfulness predicted lower end-of-treatment PTSD severity but not longest sustained abstinence from the primary substance of choice. Post hoc exploration of end-of-treatment PTSD symptom clusters indicated that higher baseline mindfulness predicted lower intrusion, negative alterations in cognitions and mood, and arousal and reactivity symptoms but not avoidance symptoms. Clinical and research implications are discussed.
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http://dx.doi.org/10.1016/j.addbeh.2019.106283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024008PMC
May 2020

Mindfulness as a predictor of cognitive-behavioral therapy outcomes in inner-city adults with posttraumatic stress and substance dependence.

Addict Behav 2020 05 30;104:106283. Epub 2019 Dec 30.

University of Texas Health Science Center at Houston, United States.

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent and difficult-to-treat. Mindfulness, defined as nonjudgmental attention to and awareness of present-moment experiences, represents a targetable mechanism with potential to predict and improve treatment outcomes for PTSD/SUD populations. We hypothesized that greater self-reported mindfulness at baseline (pre-treatment) would predict (a) lower end-of-treatment PTSD severity and (b) greater longest sustained abstinence during a 12-week cognitive-behavioral treatment program. Participants included 53 inner-city adults meeting at least four current symptoms of DSM-5 PTSD and current (DSM-IV) substance dependence (51% women; 75.5% African American; Mage = 45.42, SD = 9.99). Hierarchical regression analysis results indicated that higher levels of baseline mindfulness predicted lower end-of-treatment PTSD severity but not longest sustained abstinence from the primary substance of choice. Post hoc exploration of end-of-treatment PTSD symptom clusters indicated that higher baseline mindfulness predicted lower intrusion, negative alterations in cognitions and mood, and arousal and reactivity symptoms but not avoidance symptoms. Clinical and research implications are discussed.
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http://dx.doi.org/10.1016/j.addbeh.2019.106283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024008PMC
May 2020

Posttraumatic stress, alcohol use, and alcohol use motives among firefighters: The role of distress tolerance.

Psychiatry Res 2019 12 7;282:112633. Epub 2019 Nov 7.

Trauma and Stress Studies Center, Department of Psychology, University of Houston, 3695 Cullen Boulevard, 126 Heyne Building, Houston, TX 77204, USA. Electronic address:

Firefighters represent a unique, vulnerable population at high risk for alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) symptomatology due to the high rates of occupational exposure to traumatic events. To inform specialized alcohol use interventions for firefighters, it is important to understand relevant malleable cognitive-affective factors related to PTSD and AUD symptoms. Distress tolerance (DT), defined as the perceived ability to withstand negative emotional states, is one promising factor relevant to this domain. The current study examined the moderating role of DT in the association of PTSD symptom severity with alcohol use severity and alcohol use motives. Participants included 652 trauma-exposed firefighters (93.3% male; M = 38.7 years, SD = 8.6) who endorsed lifetime (ever) alcohol use. Results indicated that there was a significant interactive effect of PTSD symptom severity and DT on coping-oriented alcohol use motives but not other alcohol-related outcomes. These findings were evident after adjusting for alcohol consumption, romantic relationship status, number of years in the fire service, occupational stress, and trauma load. This is the first study to concurrently examine these variables among firefighters and this line of inquiry has great potential to inform intervention efforts for this vulnerable, understudied population.
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http://dx.doi.org/10.1016/j.psychres.2019.112633DOI Listing
December 2019

A Novel, Integrated Cognitive-Behavioral Therapy for Co-Occurring Posttraumatic Stress and Substance Use Disorders: A Case Study.

Cogn Behav Pract 2019 May 27;26(2):307-322. Epub 2018 Apr 27.

University of Texas Health Science Center at Houston.

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No preferred, evidence-based treatments for PTSD/SUD comorbidity are presently available. Promising integrated treatments have combined prolonged exposure therapy with cognitive-behavioral relapse prevention therapy for SUD. We describe a case study that showcases a novel, integrated cognitive-behavioral treatment approach for PTSD/SUD, entitled Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS). The TIPSS program integrates cognitive processing therapy with cognitive-behavioral therapy for SUD for the treatment of co-occurring PTSD/SUD. The present case report, based upon a woman with PTSD comorbid with both cocaine and alcohol dependence, demonstrates that TIPSS has the potential to effectively reduce PTSD symptoms as well as substance use.
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http://dx.doi.org/10.1016/j.cbpra.2018.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800741PMC
May 2019

A Novel, Integrated Cognitive-Behavioral Therapy for Co-Occurring Posttraumatic Stress and Substance Use Disorders: A Case Study.

Cogn Behav Pract 2019 May 27;26(2):307-322. Epub 2018 Apr 27.

University of Texas Health Science Center at Houston.

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No preferred, evidence-based treatments for PTSD/SUD comorbidity are presently available. Promising integrated treatments have combined prolonged exposure therapy with cognitive-behavioral relapse prevention therapy for SUD. We describe a case study that showcases a novel, integrated cognitive-behavioral treatment approach for PTSD/SUD, entitled Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS). The TIPSS program integrates cognitive processing therapy with cognitive-behavioral therapy for SUD for the treatment of co-occurring PTSD/SUD. The present case report, based upon a woman with PTSD comorbid with both cocaine and alcohol dependence, demonstrates that TIPSS has the potential to effectively reduce PTSD symptoms as well as substance use.
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http://dx.doi.org/10.1016/j.cbpra.2018.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800741PMC
May 2019

PTSD symptom severity and impulsivity among firefighters: Associations with alcohol use.

Psychiatry Res 2019 08 26;278:315-323. Epub 2019 Jun 26.

Department of Psychology, Trauma and Stress Studies Center, University of Houston, 126 Heyne Building, Houston, TX 77204-5502, United States. Electronic address:

Firefighters represent a unique population at high risk for trauma exposure, posttraumatic stress disorder (PTSD), and alcohol use. This study explored the main and interactive effects of PTSD symptom severity and impulsivity with regard to alcohol use severity. We hypothesized that higher levels of PTSD symptom severity and impulsivity would be related to greater alcohol use severity. Covariates included trauma load, depressive symptom severity, and romantic relationship status. The sample was comprised of 654 firefighters (Mage = 38.65, SD = 8.60) who endorsed exposure to potentially traumatic events and lifetime alcohol use. Firefighters completed an online questionnaire battery. A series of hierarchical regressions was conducted. PTSD symptom severity and impulsivity were significantly, incrementally associated with alcohol use severity, and a significant interactive effect was documented; firefighters with heightened PTSD symptom severity and impulsivity had the highest levels of alcohol use severity. This line of inquiry has great potential to inform prevention and intervention efforts for this vulnerable population. Clinical and research implications are discussed.
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http://dx.doi.org/10.1016/j.psychres.2019.06.039DOI Listing
August 2019

Baseline cocaine demand predicts contingency management treatment outcomes for cocaine-use disorder.

Psychol Addict Behav 2020 Feb 24;34(1):164-174. Epub 2019 Jun 24.

Department of Psychiatry and Behavioral Sciences.

Cocaine use disorder (CUD) is a significant public health issue. Behavioral interventions such as contingency management (CM) have been demonstrated to be highly effective in promoting cocaine abstinence. However, identifying individual characteristics associated with cocaine relapse may help improve treatment outcomes. Cocaine demand is a behavioral economic measure that shares a scientific foundation with CM. In the current study, we assessed baseline cocaine demand using a hypothetical cocaine purchasing task. Participants ( = 58) consisted of treatment-seeking individuals with CUD. All participants received 1 month of CM treatment for cocaine abstinence, and treatment responders were defined as presenting 6 consecutive cocaine negative urine samples from thrice weekly clinic visits. Demand data were well described by the exponentiated demand model. Indices of demand (intensity of demand [₀], elasticity [α]) were significantly associated with recent (last 30 days) cocaine use. Importantly, linear regression revealed that CM treatment nonresponders presented significantly higher ₀ (p = .025). Subsequent quantile regression analyses examining the relationship between CM treatment response and ₀ revealed statistically reliable effects of being a nonresponder across 3 of the lower percentiles (i.e., 15, 25, and 30). Overall, these findings provide further support for the utility of exponentiated demand model. To our knowledge, this is the first study to demonstrate an association between baseline demand and contingency management response and systematically extend the findings of prior demand research to a novel drug class, cocaine. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/adb0000475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928450PMC
February 2020

Post-traumatic stress and alcohol use disorders: recent advances and future directions in cue reactivity.

Curr Opin Psychol 2019 12 10;30:109-116. Epub 2019 Apr 10.

University of Illinois - Chicago, United States.

The comorbidity of post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) is prevalent, complex, and difficult to treat. Cue reactivity paradigms offer a clinically relevant scientific avenue to advance our understanding of PTSD/AUD comorbidity and ultimately inform evidence-based interventions. Cue reactivity paradigms evoke emotional, behavioral, and/or physiological responses by manipulating external (e.g. images, smells, scripts) cues. Through evaluation of how individuals with PTSD/AUD respond to trauma or alcohol cues (e.g. craving, distress, avoidance) in 'real' time, the theoretical framework for understanding functional associations between PTSD and AUD is refined. This brief narrative review of the recent literature (2015-present) will focus upon (1) summarizing the recently published cue reactivity studies relevant to PTSD/AUD, (2) explicating the limitations of the literature, and (3) discussing future empirical directions.
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http://dx.doi.org/10.1016/j.copsyc.2019.04.003DOI Listing
December 2019

Post-traumatic stress and alcohol use disorders: recent advances and future directions in cue reactivity.

Curr Opin Psychol 2019 12 10;30:109-116. Epub 2019 Apr 10.

University of Illinois - Chicago, United States.

The comorbidity of post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) is prevalent, complex, and difficult to treat. Cue reactivity paradigms offer a clinically relevant scientific avenue to advance our understanding of PTSD/AUD comorbidity and ultimately inform evidence-based interventions. Cue reactivity paradigms evoke emotional, behavioral, and/or physiological responses by manipulating external (e.g. images, smells, scripts) cues. Through evaluation of how individuals with PTSD/AUD respond to trauma or alcohol cues (e.g. craving, distress, avoidance) in 'real' time, the theoretical framework for understanding functional associations between PTSD and AUD is refined. This brief narrative review of the recent literature (2015-present) will focus upon (1) summarizing the recently published cue reactivity studies relevant to PTSD/AUD, (2) explicating the limitations of the literature, and (3) discussing future empirical directions.
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http://dx.doi.org/10.1016/j.copsyc.2019.04.003DOI Listing
December 2019

Baseline resting heart rate variability predicts post-traumatic stress disorder treatment outcomes in adults with co-occurring substance use disorders and post-traumatic stress.

Psychophysiology 2019 08 10;56(8):e13377. Epub 2019 Apr 10.

Department of Psychology, University of Houston, Houston, Texas.

Post-traumatic stress disorder (PTSD) symptoms are highly prevalent among individuals with substance use disorders (SUD), presenting a difficult-to-treat, complex comorbidity. Prognostic factors for treatment outcomes may characterize heterogeneity of the treated population and/or implicate mechanisms of action that are salient for improving treatments. High frequency heart rate variability (HF-HRV) is a suggested biomarker for emotion regulation-the ability to generate appropriate emotional responses via the influence of the parasympathetic nervous system on the heart. This initial study investigated the utility of baseline resting HF-HRV for predicting PTSD symptoms and substance use outcomes following treatment of 37 SUD participants with comorbid PTSD symptoms. Participants completed either standard cognitive- behavioral therapy (CBT) for SUD or a novel treatment of integrated post-traumatic stress and substance use that combined CBT for SUD with cognitive processing therapy for PTSD. Analyses demonstrated that higher HF-HRV predicted greater reduction in PTSD symptoms following both types of treatment. This suggests prognostic value of HF-HRV as a predictor of PTSD treatment outcomes; those with poorer autonomic emotional regulation may not respond as well to psychotherapy in general. This hypothesis-generating analysis identifies a putative biomarker that might have utility in treatment prediction.
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http://dx.doi.org/10.1111/psyp.13377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650323PMC
August 2019

Military Veteran Status and Posttraumatic Stress Disorder Symptomatology Among Urban Firefighters: The Moderating Role of Emotion Regulation Difficulties.

J Nerv Ment Dis 2019 04;207(4):224-231

Department of Psychology, University of Houston.

A significant portion of firefighters are military veterans, and both populations experience high rates of trauma and posttraumatic stress disorder (PTSD) symptomatology. We investigated main and interactive effects of military veteran status (MVS) and emotion regulation difficulties (ERD) with regard to PTSD symptom severity in firefighters. Covariates included trauma load, number of years in the fire department, and depressive symptom severity. The sample was composed of 839 (93.9% men; mean age = 38.4, SD = 8.5) trauma-exposed firefighters who completed a web-based questionnaire battery. Structural equation modeling was used. ERD were significantly, positively associated with PTSD symptom severity (β = 0.30, confidence interval [CI] = 0.20-0.41, p < 0.001). A significant interactive effect was noted (β = 0.07, CI = 0.01-0.14, p = 0.020); firefighters who endorsed MVS and greater ERD had the highest levels of PTSD symptom severity. It is vital that future work examine associations between MVS and relevant cognitive mechanisms for the purposes of informing effective screening, intervention, and prevention programs.
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http://dx.doi.org/10.1097/NMD.0000000000000958DOI Listing
April 2019
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