Opioid coping motives and pain intensity among adults with chronic low back pain: associations with mood, pain reactivity, and opioid misuse.

Chronic low back pain (CLBP) is a significant public health problem that is associated with opioid misuse and use disorder. Despite limited evidence for the efficacy of opioids in the management of chronic pain, they continue to be prescribed and people with CLBP are at increased risk for misuse. Identifying individual difference factors involved in opioid misuse, such as pain intensity as well as reasons for using opioids (also known as motives), may provide pertinent clinical information to reduce opioid misuse among this vulnerable population. Therefore, the aims of the current study were to examine the relationships between opioid motives-to cope with pain-related distress and pain intensity, in terms of anxiety, depression, pain catastrophizing, pain-related anxiety, and opioid misuse among 300 (Mage= 45.69, SD = 11.17, 69% female) adults with CLBP currently using opioids. Results from the current study suggest that both pain intensity and motives to cope with pain-related distress with opioids were associated with all criterion variables, but the magnitude of variance explained by coping motives was larger than pain intensity in terms of opioid misuse. The present findings provide initial empirical evidence for the importance of motives to cope with pain-related distress with opioids and pain intensity in efforts to better understand opioid misuse and related clinical correlates among adults with CLBP.

Delta-8- and Delta-9-THC Use Frequency, Use Motives, and Mental Health Outcomes.

Use of delta-8-THC ("delta-8") has proliferated after the passage of the 2018 Farm Bill. Yet, research on the mental health effects of this increasingly popular cannabinoid is scant. The current study sought to examine mental health correlates of delta-8 use frequency and motives, investigate whether delta-8 use motives predict use frequency, and compare use motives and problems between delta-8 and traditional cannabis. Participants consisted of 363 self-reported delta-8 users who completed measures of delta-8 use frequency, motives, and problems that were adapted from comparable measures for cannabis, as well as measures of mental health outcomes. Delta-8 use frequency was unrelated to use problems and other mental health outcomes. Delta-8 use frequency was positively associated with social and coping motives, but negatively associated with enhancement and conformity motives. Coping and conformity motives were associated with greater depression, anxiety, insomnia, and delta-8 use problems. Participants were more likely to report coping and enhancement motives for delta-8 use compared to cannabis use, but less likely to report conformity motives. Further longitudinal research is needed to assess causality for associations between delta-8 use frequency, use motives, and mental health outcomes.

Perceived Racial/Ethnic Discrimination and Smoking Outcome Expectancies among Adult Latinx Smokers Living in the United States.

Background: Smoking-related health disparities are prevalent in the Latinx community in the United States (US). Although Social Determinants of Health (SDoH) are known to contribute to a myriad of health problems among the Latinx population, there is relatively limited work expressly aimed at elucidating SDoH among Latinx smokers. Perceived racial/ethnic discrimination is one SDoH construct that may be especially relevant to understanding smoking-related cognition for Latinx smokers in the US. Smoking outcome expectancies, reflecting beliefs about the consequences of smoking, are established cognitive processes that have been linked to the maintenance and relapse of smoking. The purpose of the present work is to investigate perceived racial/ethnic discrimination in relation to smoking outcome expectancies amongst Latinx smokers in the US. Method: Participants included 338 English-speaking Latinx adult daily cigarette smokers from the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female). Results: Results indicated that perceived racial/ethnic discrimination was related to greater levels of negative reinforcement, positive reinforcement, and appetite-weight control expectancies, but not negative consequences expectancies. Discussion: Overall, the current findings provide novel insight into the relationship between perceived racial/ethnic discrimination and smoking outcome expectancies amongst English-speaking Latinx cigarette users in the US.

Cumulative vulnerabilities and smoking abstinence: A test from a randomized clinical trial.

Smoking cessation is often associated with socioeconomic and intrapersonal vulnerabilities such as psychopathology. Yet, most research that focuses on predicting smoking cessation outcomes tends focus on a small number of possible vulnerabilities. In a secondary data analysis, we developed and empirically evaluated a comprehensive, cumulative vulnerability risk composite reflecting psychologically based transdiagnostic processes, social determinants of health, and psychopathology. Participants were adult smokers who responded to study advertisements (e.g., flyers, newspaper ads, radio announcements) for an in-person delivered 4-session smoking cessation trial (N = 267; 47% female; Mage = 39.4, SD = 13.8). Results indicated that the decline in point prevalence abstinence (PPA) from quit week to 6-month post-quit was statistically significant (p < .001). There were statistically significant effects of cumulative risk score on the intercept (p < .001) and slope (p = .01). These findings were evident in unadjusted and adjusted (controlling for sex, treatment condition, and nicotine dependence) models. The present results indicate smokers with greater cumulative vulnerability demonstrated poorer smoking cessation outcomes. There may be clinical advantages to better understanding cumulative vulnerability among treatment-seeking smokers and other smoking populations to enhance the impact of public health efforts to reduce smoking.

Indirect Effects of Negative Mood on Opioid Misuse and Dependence via Anxiety Sensitivity Subfacets: Evidence from Adults Reporting Chronic Pain.

Background: Opioid misuse in the context of pain management exacts a significant public health burden. Past work has established linkages between negative mood (i.e., symptoms of anxiety and depression) and opioid misuse/dependence, yet the mechanisms underlying these associations have received little scientific investigation. Anxiety sensitivity (AS), the fear of the negative consequences of internal states, may be relevant to better understanding negative mood-opioid relations among adults with chronic pain. Methods: Simultaneous indirect effects of negative mood on opioid misuse and opioid dependence via lower-order factors of AS (physical, cognitive, and social concerns) were examined cross-sectionally in the present study. The study sample consisted of 428 adults (74.1% female, Mage = 38.27 years, SD = 11.06) who self-reported current moderate to severe chronic pain and opioid use for chronic pain. Results: Results indicated that negative mood was (in part) indirectly related to opioid misuse (in part) via AS physical and cognitive concerns and was (in part) indirectly related to opioid dependence via AS cognitive concerns only. No significant indirect effects via social concerns were observed. Discussion and Conclusions: Findings suggest the importance of further exploring the role of anxiety sensitivity cognitive and physical concerns in terms of opioid misuse and dependence among adults with chronic pain.

Latinx Individuals Who Smoke Daily with and without a Probable Anxiety Disorder: Differences in Smoking Behavior and Beliefs about Abstinence.

There is a well-established relation between anxiety psychopathology and smoking in the general population. However, little work focuses on Latinx/Hispanic (hereafter Latinx) persons who smoke from this comorbidity perspective. The present investigation aimed to explore differences among English-speaking Latinx adults who live in the United States (US) and smoke cigarettes with and without a probable anxiety disorder in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female) who identified as Latinx and were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with a probable anxiety disorder (compared to those without) were more likely to demonstrate higher levels of cigarette dependence, severity of problems when trying to quit, perceived barriers for quitting, and negative abstinence expectancies after adjusting for key variables linked to smoking and anxiety (e.g., hazardous drinking, education). The current findings are the first to document probable anxiety disorder status as a clinically relevant factor for a wide range of smoking variables and beliefs about abstinence among Latinx persons who smoke.

Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers.

Cigarette smoking is associated with adverse physical and mental health among Latinx adults in the United States. The present investigation sought to explore the main and interactive effects of anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation, and severity of problems experienced when quitting among adult Latinx smokers. Participants included 338 Latinx adult daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that anxiety symptoms were associated with greater cigarette dependence, severity of problems when quitting, and perceived barriers for smoking cessation (effect size range: 2%-3% of variance), whereas anxiety sensitivity was related to severity of problems when quitting and perceived barriers for smoking cessation (effect size range: 2%-3% of variance). There was also a statistically significant interaction between anxiety sensitivity and anxiety symptoms for cigarette dependence; anxiety was related to cigarette dependence for Latinx smokers with higher levels of anxiety sensitivity, but not for those with lower levels of anxiety sensitivity. Overall, the present findings indicate that anxiety symptoms and anxiety sensitivity are relevant factors for better understanding cigarette dependence, problems experienced when trying to quit, and perceptions of barriers to quitting among adult Latinx smokers.

Anxiety sensitivity and cigarette use on cannabis use problems, perceived barriers for cannabis cessation, and self-efficacy for quitting among adults with cannabis use disorder.

Many individuals diagnosed with cannabis use disorder (CUD) report a desire to quit using cannabis due to problems associated with use. Yet, successful abstinence is difficult for a large subset of this population. Thus, the present study sought to elucidate potential risk factors for cannabis use problems, perceived barriers for quitting, and diminished self-efficacy for remaining abstinent. Specifically, this investigation examined cigarette user status, anxiety sensitivity, and the interplay between these individual difference factors in terms of cannabis-related problems, perceived barriers for cannabis cessation, and self-efficacy for quitting cannabis use. The sample consisted of 132 adult cannabis users who met criteria for CUD and were interested in quitting (38 % female; 63.6 % Black; Mage = 37.22; SDage = 28.79; 54.6 % current tobacco users). Findings revealed a significant interaction, such that anxiety sensitivity was related to cannabis use problems and perceived barriers for cannabis cessation among current cigarette users, but not among cigarette non-users. There was no significant interaction for self-efficacy for remaining abstinent. The current findings suggest that cigarette users constitute a subgroup that may be especially vulnerable to the effects of anxiety sensitivity in terms of cannabis use problems and perceived barriers for quitting cannabis use.

Exploring Fatigue Sensitivity in terms of Mental Health and Fatigue Severity among a Racially and Ethnically Diverse Sample with Severe Fatigue.

Background: Fatigue sensitivity, or the misattribution that fatigue symptoms will lead to negative personal consequences, is one individual difference factor related to adverse behavioral health consequences. Methods: The current study investigated whether fatigue sensitivity was related to panic symptoms, depression, as well as fatigue severity among 166 persons of diverse racial/ethnic backgrounds with severe fatigue. Results: As hypothesized, fatigue sensitivity was statistically significantly related to greater panic symptoms, general depression, and fatigue severity. These results were evident over the variance explained by age, sex, neuroticism, and somatic symptoms. Conclusions: This work is the first to evaluate fatigue sensitivity in terms of behavioral health outcomes among a racial/ethnically diverse sample with severe fatigue.

Ruminative Inertia, Emotion Regulation, and Depression: A Daily-Diary Study.

Emotional suppression and cognitive reappraisal are emotion regulation strategies that have been linked to the severity of depression. Recent research has shown that greater ruminative inertia (i.e., rumination that is more resistant to change across time) is also associated with higher levels of depressive symptoms in clinical samples. However, it is unknown how tendencies to use suppression or reappraisal might be related to the inertia of rumination from day to day. After completing a baseline assessment of depressive symptoms and trait emotional suppression and cognitive reappraisal use, undergraduates (n = 94) completed daily-diary questionnaires assessing rumination for two weeks. Both higher depressive symptoms and greater tendencies to use suppression predicted stronger ruminative inertia, while tendencies to use reappraisal were unrelated to ruminative inertia. These results suggest that maladaptive emotion regulation strategies may contribute to a pattern of rumination that is more resistant to change over time. They also provide the first evidence that ruminative inertia is positively associated with depressive symptoms in a nonclinical sample.

Difficulties regulating positive and negative emotions in relation to coping motives for alcohol use and alcohol problems among hazardous drinkers.

OBJECTIVE: Hazardous drinking is a prevalent form of alcohol misuse. Past research has examined emotion regulation difficulties as a risk factor for hazardous drinking; however, the majority of prior studies have focused on regulation of negative emotions. Recent work has implicated difficulties regulating positive emotions in relation to alcohol misuse, yet, it is largely unknown if difficulties regulating positive emotions are significantly related to alcohol misuse outcomes after accounting for difficulties regulating negative emotions. METHOD: A racially diverse sample of hazardous drinkers were recruited from a university setting (75% female, Mage = 22.1, SDage = 4.0) to participate in a treatment study. Data from baseline was used in the current study. Structural equation modeling was used to evaluate relations between difficulties regulating positive and negative emotions and alcohol problems both directly and indirectly via coping motives. RESULTS: After controlling for sex, age, and levels of negative and positive affect, positive but not negative emotion regulation difficulties were significantly associated with alcohol problems. Difficulties regulating emotions (both positive and negative), were significantly related to coping motives; each valence of difficulty was also indirectly related to alcohol problems via drinking to cope. CONCLUSIONS: Difficulties regulating emotions - both positive and negative - carry a heightened risk of engaging in coping-oriented alcohol use during drinking episodes and this maladaptive means of self-regulation may explain a common pathway to experiencing alcohol-related problems. Notably, difficulties regulating positive emotions appear to offer incremental, explanatory value over and above difficulties regulating negative emotions. Such findings offer important clinical and theoretical implications.

Depressive symptomatology and alcohol misuse among treatment-seeking military veterans: Indirect associations via ruminative thinking.

BACKGROUND: Veterans are particularly vulnerable to experiencing concurrent issues related to depression and alcohol misuse. Despite this well-established susceptibility, research explicating targetable mechanisms that can account for this comorbidity remains limited. The present study sought to examine the explanatory role of ruminative thought processing within the depression and alcohol misuse relationship. METHOD: The sample included 230 veterans presenting to a general mental health clinic at a large Veterans Affairs (VA) hospital (83% male, 58% African American, Mage = 50.61, SDage = 13.79). As part of their intake evaluation, veterans completed a brief battery of self-report questionnaires to assist with diagnostic clarification and treatment planning. RESULTS: A significant total effect was observed between depression and alcohol misuse. An indirect effect between depression and alcohol misuse via rumination was also found. Notably, when examining two subtypes of rumination, an indirect effect between depression and alcohol misuse via reflective pondering but not brooding was evinced. CONCLUSIONS: Findings suggest that ruminative thought processing may be an explanatory risk factor within the depression and alcohol misuse relationship. By testing the simultaneous indirect effects of brooding rumination and reflective pondering, the present study also offers novel insights concerning the circumstances under which reflection may become a maladaptive process.

Cognitive risk, coping-oriented substance use, and increased avoidance tendencies among depressed outpatients: A prospective investigation.

OBJECTIVE: The present study was designed to assess the interplay between depressive cognition, coping-oriented substance use, and future behavioral disengagement tendencies. Cognitive risk subtypes examined include brooding rumination, attributional bias (internal/stable/global), and dysfunctional attitudes. METHOD: Individuals were recruited from outpatient treatment settings and met criteria for a unipolar depressive disorder (N = 70; 66% female; 81% White; Mage = 31; SDage = 13.2). Participants completed self-report measures of brooding rumination, attributional style, dysfunctional attitudes, coping-oriented substance use, and behavioral disengagement tendencies following a 3-week period. RESULTS: Brooding rumination, stable attributional style, and dysfunctional attitudes were positively associated with later behavioral disengagement tendencies. Coping-oriented substance use moderated associations between both internal attributional style, as well as dysfunctional attitudes onto later behavioral disengagement. CONCLUSIONS: With regard to stress-related avoidance, subsyndromal substance use may play a detrimental role among cognitively vulnerable, depressed outpatients when said drug or alcohol use serves as a means of coping.

Coping via substance use, internal attribution bias, and their depressive interplay: Findings from a three-week daily diary study using a clinical sample.

BACKGROUND: The relationship between depression and coping-oriented substance use is extensively documented; however, the cognitive processes moderating this bidirectional relationship are not well-understood. The present study investigated whether internal attribution bias coupled with a tendency to use drugs and/or alcohol to cope predicts increases in depression and daily-levels of general negative affectivity, sadness, and hostility. METHOD: Sixty-seven adults diagnosed with depression were recruited from out-patient treatment settings (66% female, 81% White, Mage = 31, SDage = 13.2). Participants completed measures on substance-related coping, depression, attributional style, and daily affect over a three-week period. RESULTS: Substance use to cope predicted increases in depression among individuals with high-level internal attribution bias. Further, coping via substance use moderated the relationship between internal attribution bias and daily-level sadness, such that sadness was highest among individuals with a high internal attribution bias coupled with greater levels of coping via substance use. A modest, yet, non-significant upward trend in daily-level hostility was also observed. CONCLUSIONS: Results suggested that depressed individuals who habitually perceive themselves as being responsible or blameworthy for negative life events are at an increased risk of worsening depressive symptoms and experiencing greater daily levels of sadness over a relatively brief period of time, particularly, when tending to engage in substance use as a mechanism to cope. This interaction effect can elicit greater daily-level sadness as well. Findings may aid in the identification and treatment of individuals at risk of maintaining or worsening their depressive symptoms.

Stigma and disease disclosure among HIV+ individuals: the moderating role of emotion dysregulation.

Increased disclosure of HIV status has been shown to reduce disease transmission among persons living with HIV (PLHIV). HIV-related stigma has been shown to reduce HIV disclosure; however, little is known about factors that may underlie the relation between HIV-related stigma and HIV disclosure. The current study examined emotion dysregulation (i.e., maladaptive generation, processing, and modulation of one's emotions) in the relation between HIV-related stigma, sub-facets of HIV-related stigma, and HIV disclosure among PLHIV seeking psychological treatment (n = 80; 61.3% male; 56.3% African-American (non-Hispanic); Mage = 48.25, SD = 7.39). Results indicated past experiences of rejection due to one's HIV status (i.e., enacted stigma), as well as subjective beliefs regarding how PLHIV are evaluated by others (i.e., public attitudes stigma), are significantly related to HIV disclosure. Additionally, these relations are moderated by emotion dysregulation. Specifically, greater HIV-related stigma is associated with reduced HIV disclosure for individuals with greater emotion dysregulation. However, emotion dysregulation did not moderate the relations between negative self-image (e.g., shame, guilt) or disclosure concerns and HIV disclosure. Findings suggest emotion dysregulation may play a moderating role for certain types of HIV disclosure.

Sustained smoking abstinence is associated with reductions in smoking-specific experiential avoidance among treatment-seeking smokers.

BACKGROUND AND OBJECTIVES: Smoking-specific experiential avoidance is related to the maintenance of cigarette smoking. However, it is unclear whether sustained smoking abstinence is associated with subsequent reductions in smoking-specific experiential avoidance. METHODS: Daily smokers (n = 149) underwent a cessation attempt in the context of a 4-session smoking cessation treatment trial. Participants provided biochemical verification of smoking status at 1 week, 2 weeks, and 1 Month post-quit day. Smoking-specific experiential avoidance was assessed per the Avoidance and Inflexibility Scale (AIS) - the total score and two factor scores were examined at 1 Month post-quit day as a function of abstinence status. Two path models were conducted and included participant sex, treatment condition, and pre-cessation nicotine dependence, smoking-specific experiential avoidance, and presence of emotional disorders as covariates. RESULTS: After adjusting for covariates, sustained smoking abstinence was associated with a reduction in the AIS total score at Month 1 post-quit (ß = -.45, p < .001). Sustained smoking abstinence was associated with reductions across both facets of experiential avoidance -- smoking-related thoughts and feelings (ß = -.44, p < .001) and internal bodily sensations (ß = -.41, p < .001). LIMITATIONS: Biochemical verification of smoking status was confirmed only at three time points post-quit day, and continued abstinence throughout the one-month post-quitting period is not fully known. CONCLUSIONS: Sustained smoking abstinence may contribute to reductions in smoking-specific experiential avoidance. Findings add to the research documenting the relevance of experiential avoidance in various processes of smoking (including smoking abstinence).

Beyond Negative Affectivity: A Hierarchical Model of Global and Transdiagnostic Vulnerabilities for Emotional Disorders.

BACKGROUND: Negative affectivity (NA) has been linked to anxiety and depression (DEP). Identifying the common factors between anxiety and DEP is important when explaining their overlap and comorbidity. However, general factors such as NA tend to have differential relationships with different disorders, suggesting the need to identify mediators in order to explicate these relationships. METHODS: The current study tests a theoretically and empirically derived hierarchical model of emotional disorders including both a general factor (NA) and transdiagnostic risk factors [anxiety sensitivity (AS) and intolerance of uncertainty (IoU)] using structural equation modeling. AS was tested as a mid-level factor between NA and panic disorder/agoraphobia, while IoU was tested as a mid-level factor between NA and social phobia, generalized anxiety disorder, obsessive-compulsive disorder, and DEP. Data from 642 clinical outpatients with a heterogeneous presentation of emotional disorders were available for analysis. RESULTS: The hierarchical model fits the data adequately. Moreover, while a simplified model removing AS and IoU fits the data well, it resulted in a significant loss of information for all latent disorder constructs. LIMITATIONS: Data were unavailable to estimate post-traumatic stress disorder or specific phobias. Future work will need to extend to other emotional disorders. CONCLUSIONS: This study demonstrates the importance of both general factors that link disorders together and semi-specific transdiagnostic factors partially explaining their heterogeneity. Including these mid-level factors in hierarchical models of psychopathology can help account for additional variance and help to clarify the relationship between disorder constructs and NA.