Not the exercise type? Personality traits and anxiety sensitivity as predictors of objectively measured physical activity and sedentary time.

Personality traits have been investigated as predictors of sedentary behavior, while both personality traits and anxiety sensitivity have been investigated as predictors of physical activity; however, few studies employed objective measurement of these behaviors. The current study recruited 64 young adults who completed the Anxiety Sensitivity Index-3 and NEO-Personality Inventory-3, then wore accelerometers for 1 week. Results revealed that agreeableness and anxiety sensitivity were inversely associated with moderate intensity or greater physical activity; however, none of the investigated constructs predicted sedentary time. These results highlight the importance of objective measurement when studying these behaviors and clinical implications for the identification of individuals at risk for physical activity avoidance.

Does anxiety sensitivity predict addiction severity in opioid use disorder?

Increased anxiety sensitivity (AS), or the fear of anxiety-related cognitive, social, and physical symptoms which are misinterpreted as having harmful implications, has shown a relationship with substance use disorders. People with substance use disorders also experience addiction-related problems across domains of life functioning. However, few studies have evaluated the relationship between elevated AS and addiction-related problems across specific life areas. We evaluated, first, whether AS predicted addiction-related problems in a sample of treatment-refractory outpatients with opioid use disorders and, second, whether sex moderated the relationship between AS and addiction-related problems in this sample. Participants with treatment-refractory opioid use disorders (n = 92, 53.3% male) completed baseline assessments of AS (the Anxiety Sensitivity Index) and addiction-related problems (the Addiction Severity Index). Baseline AS total score was a significant independent predictor of both baseline Addiction Severity Index medical status (ß = 0.29, t = 2.84, p = .006) and psychiatric status (ß = 0.30, t = 2.99, p = .004) composite scores but was not associated with social, employment or legal difficulties. These findings were maintained when controlling for drug use severity, though baseline AS total score became a significant predictor of baseline legal difficulties (ß = -0.23, t = -2.25, p = .027). There was no moderating role of sex on the relationship between baseline AS and addiction-related problems. Our findings suggest that, regardless of sex, elevated AS predicts increased addiction-related medical and psychiatric problems, and decreased legal problems when accounting for drug use severity, in outpatients with opioid use disorders.

A placebo-controlled randomized trial of D-cycloserine augmentation of cue exposure therapy for smoking cessation.

Recent studies underscore the importance of studying d-cycloserine (DCS) augmentation under conditions of adequate cue exposure treatment (CET) and protection from reconditioning experiences. In this randomized trial, we evaluated the efficacy of DCS for augmenting CET for smoking cessation under these conditions. Sixty-two smokers attained at least 18 hours abstinence following 4 weeks of smoking cessation treatment and were randomly assigned to receive a single dose of DCS (n=30) or placebo (n=32) prior to each of two sessions of CET. Mechanistic outcomes were self-reported cravings and physiologic reactivity to smoking cues. The primary clinical outcome was 6-week, biochemically-verified, continuous tobacco abstinence. DCS, relative to placebo, augmentation of CET resulted in lower self-reported craving to smoking pictorial and in vivo cues (d = 0.8 to 1.21) in a relevant subsample of participants who were reactive to cues and free from smoking-related reconditioning experiences. Select craving outcomes were correlated with smoking abstinence, and DCS augmentation was associated with a trend toward a higher continuous abstinence rate (33% vs. 13% for placebo augmentation). DCS augmentation of CET can significantly reduce cue-induced craving, supporting the therapeutic potential of DCS augmentation when applied under appropriate conditions for adequate extinction learning.

Attending to Timely Contingencies: Promoting Physical Activity Uptake Among Adults with Serious Mental Illness with an Exercise-For-Mood vs. an Exercise-For-Fitness Prescription.

Despite evidence for both physical and mental health benefits achieved through regular exercise, most Americans fail to meet minimum recommendations. Altering the behavioral contingency from a focus on long-term health benefits to immediate mood benefits represents a novel method for exercise promotion. The current study examined a single-session exercise-for-mood intervention against two time-matched comparison conditions in 152 patients with serious mental illness attending a partial hospital program, a population marked by significant health disparities. This intervention was compared to a standard exercise-for-fitness intervention and a time-matched no-exercise control. Among patients with high levels of exercise prior to the partial hospital program, the exercise-for-mood intervention yielded significant increases in exercise. Implications for exercise promotion interventions among psychiatrically ill patients are discussed.

Relations Between Past-Week Physical Activity and Recent Nonsuicidal Self-Injury in Treatment-Seeking Psychiatric Adults.

OBJECTIVE: This research study examines the relationship between past-week physical activity and recent (i.e., within the past 30 days) nonsuicidal self-injury (NSSI) in a sample of treatment-seeking adults.  METHOD: Participants included 353 (49.29% female; mean age = 35.16 years) adults attending a partial hospitalization program for acute psychiatric issues. Data were extracted from the program's admission battery of computer-based self-report measures completed by each participant on the first treatment day. RESULTS: Participants with a recent history of NSSI (i.e., within the past 30 days) engaged in significantly less past-week physical activity than those without a history of NSSI. Group differences remained significant while controlling for anxiety, but not depression. CONCLUSION: Results suggest that, on average, individuals who have never engaged in NSSI exercise more in the week prior to entering the partial hospital program than those who have a recent history of NSSI. Regular physical activity may be an interesting area of study to explore as a promising adjunctive intervention for NSSI (e.g., vigorous exercise as a way to tolerate distress and manage urges to self-injure).

Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion.

Understanding the nature and influence of specific risk profiles is increasingly important for health behavior promotion. The purpose of this article is to document the value of two factors-anxiety sensitivity (AS) and working memory capacity (WMC)-for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors. AS is a distress-related risk factor that potentiates avoidance/coping motivations for negative health behaviors. Stress provides the conditions for negative somatic and affective states, and AS amplifies the aversiveness of these experiences and correspondingly hinders adaptive functioning. In contrast, low WMC is hypothesized to exert its effect by decreasing the capacity to filter out current temptations, attenuating a focus on longer-term goals and impairing the application of relevant coping skills at times of stress. In this review, we provide conceptual models for the separate roles of high AS and low WMC in negative health behaviors, review the influence of these factors on specific health behavior exemplars (eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep promotion), provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage specific research directions in relation to these variables.

Prevalence and Characteristics of Body Dysmorphic Disorder Among Patients in a Partial Hospital Program.

Body dysmorphic disorder (BDD) is a common disorder that is usually associated with impaired functioning and high levels of suicidality. The current study is the first to assess prevalence of BDD among patients in a partial hospital program and compare patients with and without BDD on demographic and clinical variables. Participants were 207 patients with a variety of Axis I diagnoses. Prevalence of current BDD was 7.2%, and a diagnosis of BDD did not predict worse treatment outcome in the program. Patients with current BDD were more likely to be female and younger and have more comorbid diagnoses than patients without current BDD. No other significant differences were found at baseline between patients with and without current BDD. Results indicate that BDD is relatively common among patients in partial hospital programs and that such programs may be as beneficial to patients with BDD as to other patients.

Examining the efficacy of d-cycloserine to augment therapeutic learning in depression.

Despite advances in individual and combined treatments for major depression, issues with non-response and partial-response remain relatively common, motivating the search for new treatment strategies. This study aims to develop one such novel treatment. In this proof-of-concept study, we are investigating whether the treatment enhancing effects of d-cycloserine (DCS) administration can be extended outside the extinction-learning paradigms where they have been primarily examined. Using uniform delivery of cognitive behavioral therapy (CBT) content via computer-administered interventions for depression, we are assessing the value of pre-session administrations of DCS for retention of therapeutic learning. Recall of this information is evaluated in conjunction with performance on standardized tests of memory recall with both emotional and non-emotional stimuli. Specifically, in a randomized, double-blind trial we will compare the benefits of two pre-session administrations of DCS augmentation to those achieved by similar administrations of modafinil or placebo. Because modafinil is associated with a number of discriminable effects in addition to cognitive enhancement (e.g., feelings of vigor, alertness, positive mood); whereas these effects would not be expected with DCS, we will assess drug context effects in relation to memory augmentation effects.

When Partial Hospitalization Fails: Risk Factors for Inpatient Hospitalization.

Partial hospitalization is an understudied bridge between outpatient and inpatient care. One of its primary functions is to prevent the need for inpatient hospitalization. We examined potential demographic and clinical risk factors for inpatient hospitalization for current partial hospital patients. We conducted separate multiple logistic regression analyses for patients referred from inpatient care and the community. For individuals referred from inpatient care, suicidal ideation and greater psychotic symptoms upon admission to the partial program were associated with acute inpatient re-hospitalization. For individuals referred from the community, suicidal ideation and worse relationship functioning upon partial hospital admission were significant risk factors for inpatient hospitalization. Number of previous inpatient hospitalizations and greater substance abuse were not associated with inpatient hospitalization in either sample. Implications at the provider and program level are discussed.

Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital.

OBJECTIVE: Despite the effectiveness of cognitive behavioral therapy (CBT) for depression, a significant number of patients do not respond. Data examining predictors of treatment response in settings in which CBT is delivered naturalistically are lacking. METHOD: Treatment outcome data collected at a CBT-based partial hospital (n = 956) were used to examine predictors of two types of treatment response: (a) a reliable and clinically significant change in depressive symptoms and (b) a self-rating of "very much" or "much" improved. In multiple logistic regression models, we examined predictors of response in the total sample and separately for patients with a primary diagnosis of major depressive disorder (MDD) versus patients with other primary diagnoses. RESULTS: In the total sample, higher treatment outcome expectations and fewer past hospitalizations predicted clinically significant improvement in depression symptoms, and higher treatment expectations and ethnoracial minority background predicted global improvement. In patients with primary MDD, higher treatment outcome expectations and being referred from the community (vs. inpatient hospitalization) predicted better depression response, and higher treatment outcome expectations predicted global improvement. In patients with other primary diagnoses, higher treatment outcome expectations and fewer borderline personality disorder traits predicted depression reduction, and higher treatment outcome expectations, less relationship difficulty, and female gender predicted global improvement. CONCLUSIONS: Results are generally consistent with data from randomized controlled trials on longer term outpatient CBT. Interventions that increase treatment expectancy and modifications to better target men may enhance treatment outcome. Future research should include objective outcome measures and examine mechanisms underlying treatment response.

Anxiety Sensitivity Uniquely Predicts Exercise Behaviors in Young Adults Seeking to Increase Physical Activity.

Individuals with elevated levels of anxiety sensitivity (AS) may be motivated to avoid aversive emotional or physical states, and therefore may have greater difficulty achieving healthy behavioral change. This may be particularly true for exercise, which produces many of the somatic sensations within the domain of AS concerns. Cross-sectional studies show a negative association between AS and exercise. However, little is known about how AS may prospectively affect attempts at behavior change in individuals who are motivated to increase their exercise. We recruited 145 young adults who self-identified as having a desire to increase their exercise behavior. Participants completed a web survey assessing AS and additional variables identified as important for behavior change-impulsivity, grit, perceived behavioral control, and action planning-and set a specific goal for exercising in the next week. One week later, a second survey assessed participants' success in meeting their exercise goals. We hypothesized that individuals with higher AS would choose lower exercise goals and would complete less exercise at the second survey. AS was not significantly associated with exercise goal level, but significantly and negatively predicted exercise at Time 2 and was the only variable to offer significant prediction beyond consideration of baseline exercise levels. These results underscore the importance of considering AS in relation to health behavior intentions. This is particularly apt given the absence of prediction offered by other traditional predictors of behavior change.

The Development of a Novel Measure to Assess Motives for Compensatory Eating in Response to Exercise: The CEMQ.

Compensatory eating in response to exercise may be an obstacle to achieving weight-loss and fitness goals. In this study we develop and conduct a preliminary examination of the psychometric properties of the Compensatory Eating Motives Questionnaire (CEMQ), a self-report questionnaire of motives for compensatory eating. Development and testing of the CEMQ was conducted in two student samples. Of respondents, 75% reported engaging in compensatory eating. Factor analysis yielded factors representing three domains of motives for compensatory eating: Eating for Reward, Eating for Recovery, and Eating for Relief. Internal consistency of the factors was adequate, and the factor structure was replicated. Correlations between the CEMQ subscales and trait questionnaires supported hypotheses for convergent and divergent validity. These results encourage further investigation of compensatory eating as a potential obstacle to weight loss, and support the continued assessment of the CEMQ as a tool to measure three conceptually distinct motives for compensatory eating.

Properties of the Dialectical Behavior Therapy Ways of Coping Checklist in a Diagnostically Diverse Partial Hospital Sample.

OBJECTIVE: Dialectical behavior therapy (DBT) was developed for treatment of borderline personality disorder (BPD), and adapted forms of DBT are currently used to treat bipolar disorder, eating disorders, anxiety, and depression. This study was designed to validate the Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL) DBT Skills subscale (DSS) for use in a diagnostically heterogeneous sample. METHOD: We used naturalistic data from 228 patients receiving treatment at a partial hospital program to assess psychometric properties of the DBT-WCCL DSS. We assessed interitem correlations, internal consistency, factor structure, construct validity and sensitivity to change. RESULTS: Internal consistency, construct validity, and sensitivity to change were good. The measure displayed good convergent and discriminant validity. Factor analysis results were consistent with previous research indicating a 1-factor solution for this subscale. CONCLUSIONS: Psychometric properties were similar to the original BPD sample, indicating that this measure can be used as an assessment tool for DBT skill use in a diverse psychiatric population.

Predictors of Suicidality Among Patients with Psychotic Disorders in a Partial Hospital Treatment Program.

Individuals with psychotic disorders are at increased risk for suicidality. Demographic and clinical characteristics were compared in individuals with psychotic disorders reporting either high or low suicidality. Among this sample of 259 partial hospital patients, 116 (44.8%) were classified as high risk on the suicidality section of the Mini Neuropsychiatric Interview, and 143 (55.2%) were considered low risk. Bivariate analyses revealed that patients classified as high risk demonstrated greater depression severity, more relationship difficulties, greater emotional lability, and more substance use problems. A logistic regression model indicated that substance use was the most powerful predictor of higher levels of suicidality. Monitoring and intervention for substance use should be targeted as a particularly important aspect of treatment for acutely ill patients diagnosed with psychotic disorders.

Improving the efficiency of drug use disorder screening in psychiatric settings: validation of a single-item screen.

BACKGROUND: Co-occurring drug use disorders are under-detected in psychiatrically ill populations highlighting the need for more efficient screening tools. OBJECTIVES: This study compares a single-item screening tool, previously validated in a primary care setting, to the 10-item Drug Abuse Screening Test (DAST-10) for identifying co-occurring drug use disorders among patients with severe psychiatric illness. METHODS: A total of 395 patients attending a psychiatric partial hospital program completed both the single-item screen and DAST-10. A subsample of consecutive patients (n = 67) was also administered the Structure Clinical Interview for DSM-IV (SCID-IV) as a diagnostic reference standard. RESULTS: Concordance between screening measures was moderate (κ = 0.4, p < 0.01). Sensitivity and specificity of the single-item screen and DAST-10 as compared to the SCID-IV were comparable, while area under the receiver operating curve showed better discriminatory power for the identification of drug use disorders with the single-item screen. CONCLUSIONS: In comparison to the DAST-10, the single-item screen appears to be a more efficient tool to identify co-occurring drug use disorders in a psychiatric treatment setting among patients with a range of psychiatric diagnoses.

The effects of physical activity on sleep: a meta-analytic review.

A significant body of research has investigated the effects of physical activity on sleep, yet this research has not been systematically aggregated in over a decade. As a result, the magnitude and moderators of these effects are unclear. This meta-analytical review examines the effects of acute and regular exercise on sleep, incorporating a range of outcome and moderator variables. PubMed and PsycINFO were used to identify 66 studies for inclusion in the analysis that were published through May 2013. Analyses reveal that acute exercise has small beneficial effects on total sleep time, sleep onset latency, sleep efficiency, stage 1 sleep, and slow wave sleep, a moderate beneficial effect on wake time after sleep onset, and a small effect on rapid eye movement sleep. Regular exercise has small beneficial effects on total sleep time and sleep efficiency, small-to-medium beneficial effects on sleep onset latency, and moderate beneficial effects on sleep quality. Effects were moderated by sex, age, baseline physical activity level of participants, as well as exercise type, time of day, duration, and adherence. Significant moderation was not found for exercise intensity, aerobic/anaerobic classification, or publication date. Results were discussed with regards to future avenues of research and clinical application to the treatment of insomnia.

A randomized, controlled trial of the efficacy of an interoceptive exposure-based CBT for treatment-refractory outpatients with opioid dependence.

Many patients diagnosed with opioid dependence do not adequately respond to pharmacologic, psychosocial, or combination treatment, highlighting the importance of novel treatment strategies for this population. The current study examined the efficacy of a novel behavioral treatment focusing on internal cues for drug use (Cognitive Behavioral Therapy for Interoceptive Cues; CBT-IC) relative to an active comparison condition, Individual Drug Counseling (IDC), when added to methadone maintenance treatment (MMT) among those who had not responded to MMT. Participants (N=78) were randomly assigned to receive 15 sessions of CBT-IC or IDC as an adjunct to ongoing MMT and counseling. Oral toxicology screens were the primary outcome. Results indicated no treatment differences between CBT-IC and IDC and a small, significant reduction of self-reported drug use, but no change on toxicology screens. Tests of potential moderators, including sex, anxiety sensitivity, and coping motives for drug use, did not yield significant interactions. Among opioid-dependent outpatients who have not responded to MMT and counseling, the addition of IDC or CBT-IC did not result in additive outcome benefits. These results highlight the need for more potent treatment strategies for opioid dependence, particularly among those who do not fully respond to frontline treatment.

The role of anxiety sensitivity in daily physical activity and eating behavior.

Anxiety sensitivity (AS), or the fear of somatic arousal, has been linked to both maladaptive eating behavior as well as exercise avoidance in both self-report and laboratory-based experiments. The current pilot study sought to extend these finding to the naturalistic setting. A sample of 32 adults completed affect and dietary monitoring and wore actigraphs across a three-day monitoring period. Results indicated that high AS was associated with greater calorie consumption overall in women and less consumption in men, and high AS predicted an increase in calories consumed following participants' greatest increase in negative affect in both sexes. For physical activity, results indicated an AS by BMI interaction such that obese individuals with high AS engaged in less moderate-intensity physical activity, whereas the opposite was true for normal weight individuals. These results indicate that AS may represent a double-edged risk factor for obesity contributing to both exercise avoidance and calorie consumption.

Changes in distress intolerance and treatment outcome in a partial hospital setting.

Despite the well-established role of distress intolerance (DI) in a wide range of psychological disorders, few studies have examined whether DI improves during treatment and whether these changes are associated with symptom outcomes. Patients (N=626) enrolled in a brief cognitive-behavioral partial hospital program completed pre- and posttreatment measures of DI. Results indicated that DI decreased significantly during treatment, with more than 30% of the sample exhibiting a reduction of more than 2 standard deviations from the sample mean. Women reported higher DI than men at baseline; however, there were no gender differences in changes in DI over time. Participants also completed a pre- and posttreatment measure of depression and a subset completed a measure of anxiety (n=167). DI was associated with more severe depression and anxiety at pre- and posttreatment, with participants who reported a decrease in DI also reporting lower depression and anxiety symptoms at post-treatment. These results further highlight the transdiagnostic relevance of DI and suggest that DI may be a relevant factor in treatment outcome for depression and anxiety.

Predictors of dropout from psychosocial treatment in opioid-dependent outpatients.

BACKGROUND AND OBJECTIVES: Early dropout is common in substance abuse treatment settings and may lead to poorer outcomes relative to those completing a full course of treatment. Attempts to identify predictors of dropout have yielded mixed results, highlighting the need for additional research in this area to clarify risk and protective factors to guide intervention and retention efforts. This study evaluated predictors of dropout from psychosocial treatment among opioid-dependent patients on methadone maintenance therapy. METHODS: Participants included 78 patients who had failed to respond to at least 4 months of methadone maintenance plus group counseling with clinic substance abuse counselors, and were enrolled in a study of randomized psychosocial treatment in addition to treatment-as-usual. Several factors that have been implicated in previous studies as well as two affective variables (distress intolerance and coping motives for drug use) were examined. RESULTS: Results indicated that when controlling for various risk factors, age was the only significant predictor of dropout, with younger patients more likely to discontinue treatment early. CONCLUSIONS: This study replicates previous findings in opioid-dependent samples that younger patients are at an increased risk of early treatment dropout. CONCLUSIONS AND SIGNIFICANCE: Targeted intervention may be needed to retain young patients in drug abuse treatment.