Trajectory of change in anxiety sensitivity in relation to anxiety, depression, and quality of life among persons living with HIV/AIDS following transdiagnostic cognitive-behavioral therapy.

Persons living with HIV/AIDS (PLHIV) disproportionately suffer from anxiety and depressive symptoms and disorders. Although past work has examined the efficacy of cognitive-behavioral therapy (CBT) for depression, and to a lesser extent anxiety, among PLHIV, little is known regarding potential mechanisms underlying improvement in anxiety/depression among this group. Anxiety sensitivity is a well-established risk/maintenance factor for anxiety and depressive disorders and is hypothesized to play an important role in maintaining anxiety among PLHIV. Past work has identified anxiety sensitivity as a mechanism of action underlying changes in various anxiety domains yet it is unknown whether changes in anxiety sensitivity relate to changes in anxiety symptoms among PLHIV undergoing transdiagnostic CBT for anxiety. The current study sought to examine treatment-related changes in anxiety sensitivity and how the trajectory of change relates to anxiety and depressive symptoms as well as overall quality of life. Individuals (n = 35) with HIV/AIDS and elevated anxiety symptoms received CBT for anxiety. Results indicated that reductions in anxiety sensitivity were significantly related to changes in anxiety, depression, and quality of life. Together, these data suggest that changes in anxiety sensitivity are significantly related to changes in anxiety/depression and quality of life among PLHIV seeking treatment.

Emotion dysregulation in the experience of pain among persons living with HIV/AIDS.

Persons living with HIV and AIDS (PLWHA) report disproportionally high rates of pain. Pain among PLWHA has been associated with poor medication adherence and anxiety and depressive symptoms. This relationship may be primarily driven by elevated negative affect, and one factor that may be important to understanding elevated negative affect is emotion dysregulation. Therefore, the current study sought to examine emotion dysregulation (Difficulties in Emotion Regulation Scale) in terms of multi-dimensional pain experience (pain severity, pain interference, pain affective distress, pain life control; Multidimensional Pain Inventory; Turk and Rudy (1988) among a sample of 162 HIV+ individuals (Mage = 47.65, SD = 8.59, 35.2% female). Two-step hierarchical regression analyses revealed that emotion dysregulation total score was significantly associated with each of the pain variables. These results may suggest PLWHA who demonstrate greater emotion dysregulation struggle to effectively manage negative affect associated with their pain experience, exacerbating the severity of pain symptoms across numerous clinically-relevant domains. The novel findings may provide important assessment and intervention targets for PLWHA living with pain.

The Impact of Integrating Physical Health into a Brief CBT Approach for Medically Ill Veterans.

The current study explored the use and preliminary outcomes of physical health treatment elements integrated into a traditional brief cognitive behavioral therapy (bCBT) approach for medically ill veterans with depression and/or anxiety. Data were collected as part of a pragmatic randomized trial examining patient outcomes of bCBT versus an enhanced usual care condition. bCBT was delivered to participants by Veterans Health Administration (VA) mental health providers in the primary care setting. Using a skill-based approach, providers and participants selected modules from a list of intervention strategies. Modules included Taking Control of Your Physical Health, Using Thoughts to Improve Wellness, Increasing Pleasant Activities, and Learning How to Relax. Skill module use and impact on treatment completion and clinical outcomes were explored for participants randomized to bCBT who received at least one skill module (n = 127). Utilization data showed that participants and providers most commonly selected the physical health module for the first skill session. Receiving the "physical health" and "thoughts" modules earlier in treatment were associated with a higher likelihood of treatment completion (defined as four or more sessions). Preliminary outcome data suggest that the physical health skill module was equally effective or superior to other bCBT skill modules. Results suggest that incorporating physical health elements with a bCBT approach hold the potential to positively impact treatment engagement/completion and may result in improved outcomes for medically ill patient populations.

Emotion Dysregulation: An Explanatory Construct in the Relation Between HIV-Related Stigma and Hazardous Drinking among Persons Living with HIV/AIDS.

The prevalence of hazardous alcohol use among people living with HIV/AIDS (PLHIV) is common and related to numerous health problems among individuals in this group. Stigma is associated with hazardous drinking among stigmatized groups, but this relationship has yet to be examined among PLHIV. Moreover, there is a lack of research in identifying the mechanisms underlying this association. Emotion dysregulation is one potential construct that may explain the association between stigma and hazardous alcohol use among PLHIV. The present study examined the indirect effect of HIV stigma and hazardous alcohol use via emotion dysregulation. The sample included 98 PLHIV (60.2% male, M age = 48.40, SD = 7.75). Results indicated significant and medium-sized indirect effects of HIV stigma and its subfacets (enacted stigma and negative self-image) in terms of hazardous alcohol use via emotion dysregulation. Alternative models did not yield significant indirect effects. The results document an indirect association between HIV stigma and hazardous alcohol use via emotion dysregulation. These findings may provide novel, initial empirical insight into the nature of the stigma-hazardous drinking relation among PLHIV.

HIV Anxiety Reduction/Management Program (HAMRT): pilot randomized controlled trial.

Research has indicated that mental health disorders, particularly anxiety, predicts poorer antiretroviral medication adherence among persons living with HIV/AIDS (PLWHA). The present study tests a novel six-session Cognitive-Behavioral Therapy-based integrated treatment/management program for PLWHA with concurrent anxiety delivered in community health clinics Houston, Texas. Twenty-Seven PLWHA (Mage = 48.5, SD = 8.9, 44.4% female) were recruited for a proof-of-concept study and randomized to either an active treatment condition, or a waitlist control condition of equal length. Participants were assessed pre-randomization, at the mid-treatment time point (after three sessions for the active participants and three weeks for the control participants) and post-treatment (six sessions for active participants, six weeks for control participants). Data were examined used Bayesian multilevel models. Results indicated a reliable (99.87% posterior probability of a moderating effect) interaction between active and control groups for depressive symptoms and reliable (99.65% probability) interaction for anxiety symptoms. Results indicated an unreliable interaction for combined antiretroviral therapy adherence. These findings are discussed in terms of the feasibility and potential utility of administering an anxiety-reduction therapy program designed for PLWHA with HIV medication adherence difficulties.

Cross-sectional relations between psychological inflexibility and symptoms of depression and anxiety among adults reporting migraines or risk factors for cardiovascular disease.

Psychological inflexibility is a multifaceted construct reflecting a rigid dominance of psychological reactions over chosen values and contingencies in guiding action. Psychological inflexibility has been related to depressive and anxiety symptoms and has been studied as a target of treatment for different forms of psychopathology. This construct, however, remains understudied among some at-risk groups. To close this gap in knowledge, the current study examined cross-sectional relations between psychological inflexibility and (1) symptoms of depression among adults with migraines (n = 2936) and (2) symptoms of anxiety and depression among adults at-risk for cardiovascular disease (n = 921). Results indicate that psychological inflexibility significantly related to depressive and anxiety symptoms among these populations. Results are discussed in terms of treatment implications for such persons.

Examining HIV-Related stigma in relation to pain interference and psychological inflexibility among persons living with HIV/AIDS: The role of anxiety sensitivity.

Pain is highly prevalent among people living with HIV (PLHIV). Although the association between stigma and pain among stigmatized individuals has been well-established in the non- HIV chronic pain literature, little is known about the association between stigma and pain among PLHIV and the mechanisms that underlie this association. The present study examined the indirect effect of HIV stigma and pain via anxiety sensitivity (fear of anxiety symptoms). The sample included 97 PLHIV (60.2% male, Mage = 48.40, SD = 7.75). Results indicated significant and medium-sized indirect effects of HIV stigma on pain severity, pain interference, and psychological inflexibility in pain via anxiety sensitivity. Alternative models did not yield significant indirect effects. The results suggest anxiety sensitivity may explain the association between stigma and pain among PLHIV. These findings provide novel empirical insight into the nature of stigma-pain relation among PLHIV and could be used to guide pain-based intervention development for this population.

A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication Adherence Among Persons Living With HIV/AIDS.

Persons living with HIV/AIDS (PLHIV) are able to live full lifespans after infection, however, rates of anxiety disorders among this population are elevated compared to national samples. Importantly, these anxiety symptoms and disorders have a negative effect on medication adherence, quality of life and other psychological disorders, such as depression. In order to reduce the impact of anxiety among PLHIV, a six-session transdiagnostic CBT-based treatment manual for anxiety among PLHIV named the HIV/Anxiety Management-Reduction Treatment (HAMRT) was developed and implemented. The current manuscript discusses the content of this manual as well as results from three cases examining the impact of HAMRT. Results indicated that HAMRT was effective in reducing symptoms of anxiety, anxiety sensitivity, depression, and negative affect among our sample. Additionally, results indicated that HAMRT was effective in increasing HIV medication adherence as well as quality of life. Results are discussed in terms of the potential utility of an anxiety-reduction therapy program aimed at increasing medication adherence among PLHIV.

Exploring Distress Tolerance as an Underlying Mechanism in the Relation Between Negative Affectivity and Anxiety/Depression Among Persons Living with HIV/AIDS.

Persons living with HIV/AIDS (PLHIV) suffer disproportionately from a variety of mood disorders relative to the general population, yet, there is little understanding of the underlying nature behind this. The present study explored the indirect effect of perceived distress tolerance in relation between negative affectivity and anxiety/depressive symptoms and disorders among PLHIV. Participants included 97 PLHIV (60.8% male; 66% Minority; M age = 48.5 years, SE = 7.7). Results revealed indirect effects of negative affectivity via perceived distress tolerance in relation to social anxiety, depression symptoms, as well as the existence of any anxiety disorder; findings were evident after controlling for covariates. Perceived distress tolerance may serve as a construct to aid understanding in the relation between negative affectivity and the expression of anxiety/depressive symptoms and disorders among PLHIV. Future work may consider addressing distress tolerance in efforts to offset the severity of the expression of anxiety/depressive symptoms among PLHIV.

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.

Main and interactive effects of emotion dysregulation and HIV symptom severity on quality of life among persons living with HIV/AIDS.

HIV symptoms are associated with a poorer quality of life (QOL) among persons living with HIV/AIDS (PLWHA). Yet, there is little understanding of emotional factors that impact the relation between HIV symptom severity and QOL. The present study examined the main and interactive effects of emotion dysregulation and HIV symptom severity on multiple indices of QOL, including physical (impact of physical problems related to HIV), psychological (frequency of negative feelings), independence (necessity of medical treatment to function in daily life), social (feelings of acceptance), environmental (satisfaction with living conditions and medical care), and spiritual (fear of the future and death) among a sample of 74 PLWHA. Participants (72.9% male; mean age = 48.24, SD = 7.85) were recruited from AIDS Service Organizations in the United States. Results indicated that higher HIV symptom severity is significantly associated with lower physical and independence QOL, whereas higher emotion dysregulation is significantly associated with lower scores on all measured aspects of QOL. Additionally, results indicated that the interaction of emotion dysregulation and HIV symptom severity was significantly associated with both physical and environmental QOL. The form of the observed significant interactions indicated that HIV symptom severity was related to poorer QOL among those with lower (versus higher) emotion dysregulation. The present findings indicate that emotion dysregulation is related to QOL among PLWHA and may interact with HIV symptom severity to negatively impact certain aspects of QOL. Given the profound impact that HIV has on QOL, this finding is important in understanding these relations mechanistically, and may be important in the development of novel psychological treatment strategies.

Examining anxiety sensitivity as an explanatory construct underlying HIV-related stigma: Relations to anxious arousal, social anxiety, and HIV symptoms among persons living with HIV.

Persons living with HIV (PLHIV) are a health disparity subgroup of the overall population for mental and physical health problems. HIV-related stigma has been shown to increase anxiety symptoms and HIV symptoms among PLHIV. However, little is known about factors that may impact the relations between HIV-related stigma and anxiety symptoms and HIV symptoms among PLHIV. To address this gap in the literature, the current study examined anxiety sensitivity (i.e., the extent to which individuals believe anxiety and anxiety-related sensations) in the relation between HIV-related stigma, social anxiety, anxious arousal, and HIV symptoms among a sample of 87 PLHIV (60.9% cis gender male, 52.9% Black, non-Hispanic). Results indicated that anxiety sensitivity mediated the relations between HIV-related stigma and the dependent variables, with effect sizes indicating moderate to large effects of anxiety sensitivity on these relations. Findings suggest that anxiety sensitivity be a mechanistic factor in the relations between HIV-related stigma and social anxiety, anxious arousal, and HIV symptoms, and therefore, be important element in efforts to reduce mental/physical health disparity among this population.

Anxiety sensitivity and hazardous drinking among persons living with HIV/AIDS: An examination of the role of emotion dysregulation.

Hazardous drinking is prevalent among persons living with HIV/AIDS (PLWHA). Anxiety sensitivity is a vulnerability factor that is highly associated with hazardous drinking among seronegatives, but has yet to be tested in PLWHA. Additionally, there is a need to examine potential mechanisms underlying associations of anxiety sensitivity and hazardous drinking. Emotion dysregulation is one potential construct that may explain the association between anxiety sensitivity and hazardous drinking. The current study examined emotion dysregulation as a potential explanatory variable between anxiety sensitivity and four, clinically significant alcohol-related outcomes among PLWHA: hazardous drinking, symptoms of alcohol dependence, number of days consuming alcohol within the past month, and degree of past heavy episodic drinking. The sample included 126 PLWHA (Mage=48.3; SD=7.5; 65.9% male). Results indicated significant indirect effects of anxiety sensitivity via emotion dysregulation in all models. Indirect effects (κ(2)) were of medium effect size. Alternative models were run reversing the predictor with mediator and, separately, reversing the mediator with the proposed outcome(s); alternative models yielded non-significant indirect effects in all but one case. Together, the current results indicate that anxiety sensitivity is associated emotion dysregulation, which, in turn, is associated with hazardous drinking outcomes. Overall, these findings may provide initial empirical evidence that emotion dysregulation may be a clinical intervention target for hazardous drinking.

Interplay of dysphoria and anxiety sensitivity in relation to emotion regulatory cognitions of smoking among treatment-seeking smokers.

BACKGROUND AND OBJECTIVES: There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet there is little understanding of how AS interplays with other affective symptomatology variables that are also related to smoking, such as dysphoria. Therefore, the current cross-sectional study evaluated the interactive effects of AS and dysphoria on emotion regulatory cognitions, including smoking negative affect reduction expectancies, perceived barriers for cessation, and smoking-specific experiential avoidance. METHOD: A total of 448 adult treatment-seeking daily smokers, who responded to study advertisements, were recruited to participate in a smoking cessation treatment trial (47.8% female; Mage = 37.2, SD = 13.5). The current study utilized self-report baseline data from trial participants. RESULTS: After accounting for covariates, simple slope analyses revealed that AS was positively related to negative affect reduction expectancies (ß = .03, p = .01), perceived barriers to cessation (ß = .22, p = .002), and smoking avoidance and inflexibility (ß = .07, p = .04), among smokers with lower (vs. higher) levels of dysphoria. CONCLUSIONS: The current findings suggest that higher levels of dysphoria may mitigate the relation between AS and emotion regulatory cognitions of smoking. SCIENTIFIC SIGNIFICANCE: The current findings highlight the unique and additive clinical relevance of AS and dysphoria regarding emotion regulatory smoking cognitions that may impede quit success. (Am J Addict 2016;25:267-274).

Pain-related anxiety in relation to anxiety and depression among persons living with HIV/AIDS.

Persons living with HIV/AIDS (PLHA) experience clinically significant pain as a result of HIV and such pain is often related to increased levels of anxiety/depression. Pain-related anxiety has been identified as a mechanism in the onset and progression of pain experience and associated affective distress. However, there has not been empirical study of pain-related anxiety in relation to affective processes among PLHA. To address this gap, hierarchical multiple regressions were conducted using SPSS v.21 to examine pain-related anxiety (as measured using the Pain Anxiety Symptoms Scale) in relation to anxiety and depressive symptoms (as measured using the Mood and Anxiety Symptoms Questionnaire) among 93 PLHA (10.8% female; Mean age = 49.63, SD = 8.89). Pain-related anxiety was significantly related to anxious arousal symptoms (ß = .43) and anhedonic depressive symptoms (ß = .25); effects were evident beyond the variance accounted for by CD4 count, race, sex, income level, and current level of bodily pain. The present results suggest that pain-related anxiety may play a role in the experience of anxiety and depressive symptoms among PLHA.

The Moderating Role of Smoking Amount Per Day on the Relations Between Anxiety Sensitivity, Smoking Dependence, and Cognitive-Affective Aspects of Smoking Among Treatment Seeking Smokers.

The current study examined the moderating effects of smoking amount per day on the relation between anxiety sensitivity and nicotine dependence, cigarette smoking outcome expectancies, and reasons for quitting smoking among 465 adult, treatment-seeking smokers (48% female; Mage = 36.6, SD = 13.5). Smoking amount per day moderated the relation between anxiety sensitivity and nicotine dependence, smoking expectancies for negative consequences and appetite control as well as intrinsic reasons for quitting. However, no moderating effect was evident for negative reinforcement expectancies. The form of the significant interactions indicated across dependent variables lower levels of smoking amount per day suppressed the relation between anxiety sensitivity and smoking related dependent variable, such that the positive relation of anxiety sensitivity to smoking dependence and cognitive-affective aspects of smoking is weaker in heavier smokers and more robust in lighter smokers.

Developing scales measuring disorder-specific intolerance of uncertainty (DSIU): a new perspective on transdiagnostic.

Intolerance of uncertainty (IU) is a construct of growing prominence in literature on anxiety disorders and major depressive disorder. Existing measures of IU do not define the uncertainty that respondents perceive as distressing. To address this limitation, we developed eight scales measuring disorder-specific intolerance of uncertainty (DSIU) relating to various anxiety disorders and major depressive disorder. We used exploratory factor analysis and item characteristic curves in two large undergraduate samples (Ns=627 and 628) to derive eight three-item DSIU scales (24 items total) that exhibited excellent psychometric properties. Confirmatory factor analysis supported the factor structures of the scales and the transdiagnostic nature of IU. Each scale predicted unique variance in its respective symptom measure beyond a traditional measure of IU. DSIU represents a theoretically proximal and causal intermediary between known vulnerability factors and disorder symptomatology. The DSIU scales can be used to advance theories of psychopathology and inform case conceptualization and treatment planning.

Cultural-based biases of the GAD-7.

The GAD-7 is a popular measure of generalized anxiety disorder (GAD) symptoms that has been used across many cultural groups. Existing evidence demonstrates that the prevalence of GAD varies across self-identified ethnic/cultural groups, a phenomenon that some researchers attribute to cross-cultural measurement error rather than to actual differences in rates of GAD. Nonetheless, the effect of culture on factor structure and response patterns to the GAD-7 have not been examined and could result over- or under-estimated GAD-7 scores across different cultural groups. The current investigation assessed the factor structure of the GAD-7 in White/Caucasian, Hispanic, and Black/African American undergraduates and tested for cultural-based biases. A modified one-factor model exhibited good fit across subsamples. Results revealed that Black/African American participants with high GAD symptoms scored lower on the GAD-7 than other participants with similar GAD symptoms. Results highlight the need for culturally sensitive GAD screening tools.

The mediating role of anxiety sensitivity in the relation between avoidant coping and posttraumatic stress among trauma-exposed HIV+ individuals.

The current study examined the mediating role of anxiety sensitivity in regard to the relation between avoidant coping and posttraumatic stress (PTS) symptoms among trauma-exposed persons living with HIV/AIDS (PLHA). Participants included 103 PLHA (18.4% female, Mage = 48.33, SD = 9.34). Results indicated significant positive indirect effects for avoidant coping through anxiety sensitivity on overall PTS symptoms (point estimate = .27, PB 95% CI [.01, .65]), PTS hyperarousal symptoms (point estimate = .09, PB 95% CI [.01, .21]), and PTS avoidant symptoms (point estimate = .14, PB 95% CI [.03, .30]). The observed findings were statistically significant and evident above and beyond the variance accounted for by CD4 cell count, race, sex, recruitment site, and lifetime number of traumatic events experienced. The results may indicate that avoidant coping affects PTS symptoms through anxiety sensitivity among trauma-exposed PLHA. These findings highlight the importance of anxiety sensitivity in relation to PTS symptoms among PLHA, and the possibility of adapting anxiety sensitivity reduction training for PTS symptoms among PLHA.