Development of an Anxiety Sensitivity (AS) Intervention for High-AS Individuals in Substance Use Disorders Treatment

Abstract

Substance use disorders (SUDs) and anxiety disorders commonly co-occur, yet to date no empirically-supported treatments for this combination of disorders has been developed. One potential way of treating these issues simultaneously may be to target anxiety sensitivity (AS), which is a risk factor for development of both SUDs and problematic anxiety. The objectives of the current study were to develop and pilot test a brief treatment aimed at reducing AS and substance use. Twenty-one individuals concurrently participating in a community-based intensive outpatient SUD treatment program received six 1.5-h sessions of an AS-targeted intervention, primarily utilizing interoceptive exposures, cognitive challenging, and psychoeducation about the relationship between substance use and anxiety. At post-treatment, participants had significant reductions in AS as measured by the Anxiety Sensitivity Index (d = 1.62; ASI; Reiss et al. in Behav Res Ther 24(1):1–8, 1986), and significant decreases in percent days abstinent from substances (Cohen’s d = 1.35). Average scores on the ASI at pre-treatment were in the clinical range (M = 41.5, SD = 9.97) but had moved to the nonclinical range on the ASI at 3 months follow-up (M = 20.8, SD = 9.39; intent to treat analysis). Participants had large reductions in the Depression–Anxiety–Stress Scale (Lovibond and Lovibond in Manual for the Depression Anxiety Stress Scales. Psychology Foundation Monograph, Sydney, 1995) anxiety subscale scores but remained in the moderate range on this subscale at follow-up. Subjective reports of both participants and therapists described the intervention as tolerable, effective, and desired. Results of the current open trial suggest that a relatively brief (<9 h) anxiety sensitivity intervention may be promising for reducing both anxiety sensitivity and in turn, frequency of substance use and anxiety symptoms.