Higher Levels Of Anxiety Sensitivity Research Articles

CLINICAL CONSEQUENCES OF THE REVISED DSM-5 DEFINITION OF AGORAPHOBIA IN TREATMENT-SEEKING ANXIOUS YOUTH

In DSM-5, the agoraphobia core symptom criterion has been revised to require fear about multiple situations from across at least two distinct domains in which escape might be difficult or panic-like symptoms might develop. The present study examined patterns and correlates of the recent change in a sample of anxious youth with symptom presentations consistent with the DSM-IV agoraphobia definition and/or specific phobia (SP) to consider how the recent diagnostic change impacts the prevalence and composition of agoraphobia in children and adolescents. Analyses (N = 151) evaluated impairment and correlates of agoraphobic youth who no longer meet the DSM-5 agoraphobia criteria relative to agoraphobic youth who do meet the new DSM-5 criteria. Secondary analyses compared agoraphobic youth not meeting DSM-5 criteria to SP youth. One-quarter of youth with symptom presentations consistent with the DSM-IV agoraphobia definition no longer met criteria for DSM-5 agoraphobia, but showed comparable severity and impairment across most domains to youth who do meet criteria for DSM-5 agoraphobia. Further, these youth showed higher levels of anxiety sensitivity and internalizing psychopathology relative to youth with SP. A substantial proportion of impaired youth with considerable agoraphobic symptom presentations have been left without a specified anxiety diagnosis by the DSM-5, which may affect their ability to receive and/or get coverage for services and their representation in treatment evaluations. Future DSM iterations may do well to include a "circumscribed" agoraphobia specifier that would characterize presentations of fear or anxiety about multiple situations, but that do not span across at least two distinct situational domains.

Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care

The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; Mage=39.0, SD=10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.

Anxiety sensitivity and pre-cessation smoking processes: testing the independent and combined mediating effects of negative affect-reduction expectancies and motives.

Anxiety sensitivity appears to be relevant in understanding the nature of emotional symptoms and disorders associated with smoking. Negative-reinforcement smoking expectancies and motives are implicated as core regulatory processes that may explain, in part, the anxiety sensitivity-smoking interrelations; however, these pathways have received little empirical attention. Participants (N = 471) were adult treatment-seeking daily smokers assessed for a smoking-cessation trial who provided baseline data; 157 participants provided within-treatment (pre-cessation) data. Anxiety sensitivity was examined as a cross-sectional predictor of several baseline smoking processes (nicotine dependence, perceived barriers to cessation, severity of prior withdrawal-related quit problems) and pre-cessation processes including nicotine withdrawal and smoking urges (assessed during 3 weeks before the quit day). Baseline negative-reinforcement smoking expectancies and motives were tested as simultaneous mediators via parallel multiple mediator models. Higher levels of anxiety sensitivity were related to higher levels of nicotine dependence, greater perceived barriers to smoking cessation, more severe withdrawal-related problems during prior quit attempts, and greater average withdrawal before the quit day; effects were indirectly explained by the combination of both mediators. Higher levels of anxiety sensitivity were not directly related to pre-cessation smoking urges but were indirectly related through the independent and combined effects of the mediators. These empirical findings bolster theoretical models of anxiety sensitivity and smoking and identify targets for nicotine dependence etiology research and cessation interventions.

Examining the latent structure of anxiety sensitivity in adolescents using factor mixture modeling.

Anxiety sensitivity has been implicated as an important risk factor, generalizable to most anxiety disorders. In adults, factor mixture modeling has been used to demonstrate that anxiety sensitivity is best conceptualized as categorical between individuals. That is, whereas most adults appear to possess normative levels of anxiety sensitivity, a small subset of the population appears to possess abnormally high levels of anxiety sensitivity. Further, those in the high anxiety sensitivity group are at increased risk of having high levels of anxiety and of having an anxiety disorder. This study was designed to determine whether these findings extend to adolescents. Factor mixture modeling was used to examine the best fitting model of anxiety sensitivity in a sample of 277 adolescents (M age = 11.0 years, SD = 0.81). Consistent with research in adults, the best fitting model consisted of 2 classes, 1 containing adolescents with high levels of anxiety sensitivity (n = 25) and another containing adolescents with normative levels of anxiety sensitivity (n = 252). Examination of anxiety sensitivity subscales revealed that the social concerns subscale was not important for classification of individuals. Convergent and discriminant validity of anxiety sensitivity classes were found in that membership in the high anxiety sensitivity class was associated with higher mean levels of anxiety symptoms, controlling for depression and externalizing problems, and was not associated with higher mean levels of depression or externalizing symptoms controlling for anxiety problems.

Anxiety sensitivity as an amplifier of subjective and behavioral tobacco abstinence effects

BackgroundAnxiety sensitivity, a transdiagnostic cognitive vulnerability factor described as an amplifier of negative emotional states, is implicated in the maintenance of cigarette smoking and cessation difficulties. The current study aimed to examine the role of anxiety sensitivity in predicting abstinence-induced changes in nicotine withdrawal, smoking urges and smoking behavior during an experimental relapse analogue task (RAT). MethodParticipants were 258 non-treatment seeking smokers (M [SD] age=44.0 [10.73]; 69.8% male). Participants attended two counterbalanced experimental sessions including smoking deprivation (16h of smoking abstinence) and smoking as usual. The Minnesota Nicotine Withdrawal Scale (MNWS) and Brief Questionnaire of Smoking Urges (QSU) were completed at each session in addition to the RAT. Hierarchical regressions were conducted to examine the predictive impact of anxiety sensitivity on withdrawal and urges during smoking deprivation. Follow-up mediational analyses were conducted to examine whether abstinence-induced withdrawal and urges mediated responding during the RAT. ResultsAnxiety sensitivity amplified the effects of experimentally manipulated acute abstinence on subjective nicotine withdrawal symptoms and smoking urges. Additionally, higher levels of anxiety sensitivity indirectly predicted shorter latency to smoking initiation after deprivation during the RAT through the effects of greater abstinence-induced nicotine withdrawal and smoking urges. Anxiety sensitivity was unrelated to increased smoking during the RAT, although this may be partially attributed to the type of laboratory assessment employed. ConclusionsElevated anxiety sensitivity appears to impact initiation of smoking after nicotine deprivation through the effects of abstinence-induced withdrawal and smoking urges.

Internal focus of attention in anxiety-sensitive females up-regulates amygdale activity: an fMRI study.

Cognitive behavioral models of panic disorder (PD) stress the importance of an increased attentional focus towards bodily symptoms in the onset and maintenance of this debilitating anxiety disorder. In this fMRI mental tracking paradigm, we looked at the effects of focusing one's attention internally (interoception) vs. externally (exteroception) in a well-studied group at risk for PD-that is anxiety-sensitive females (AS-high). We hypothesized that AS-high subjects compared to control subjects will present higher arousal and decreased valence scores during interoception and parallel higher activity in brain areas which are associated with fear and interoception. 24 healthy female students with high levels of anxiety sensitivity and 24 healthy female students with normal levels of anxiety sensitivity serving as control group were investigated by 3T fMRI. Subjects either focused their attention on their heartbeats (internal condition) or on neutral tones (external condition). Task performance was monitored by reporting the number of heartbeats or tones after each block. State of arousal and emotional valence were also assessed. The high anxiety-sensitive group reported higher arousal scores compared to controls during the course of the experiment. Simultaneously, fMRI results indicated higher activation in anxiety-sensitive participants than in controls during interoception in a network of cortical and subcortical brain regions (thalamus, amygdala, parahippocampus) that overlaps with known fear circuitry structures. In particular, the activity of the right amygdala was up-regulated. Future prospective-longitudinal studies are needed to validate the role of the amygdala for transition to disorder. Attention to internal body functions up-regulates the activity of interoceptive and fear-relevant brain regions in anxiety-sensitive females, a high-risk group for the development of anxiety disorders.

The Interaction of Extraversion and Anxiety Sensitivity on Social Anxiety: Evidence of Specificity Relative to Depression

Neuroticism and extraversion have been linked to the etiologies and course of anxiety and mood disorders, such that neuroticism is broadly associated with numerous disorders and extraversion is most strongly associated with social anxiety and depression. While previous research has established the broad associations between temperament and emotional disorders, less is known about the specific, proximal factors that are associated with them, and very few studies have situated these risk factors into a larger etiological model that specifies how they may relate to one another. The current study examined the interaction of extraversion and anxiety sensitivity (AS) in predicting social anxiety symptoms in a large, diagnostically diverse clinical sample (N=826). Symptoms were assessed with self-report and dimensional interview measures, and regression analyses were performed examining the main effects and interaction of extraversion and AS (examining both total and lower-order components) on social anxiety. Results showed that at higher levels of AS, the inverse relationship between extraversion and social anxiety was stronger, and the social concerns component of AS is responsible for this effect. This interaction was also observed with regard to depression symptoms, but the interaction was not present after accounting for shared variance (i.e., comorbidity) between depression and social anxiety symptoms. Clinical and theoretical implications of the results are discussed.

Psychological inflexibility mediates the effects of self-efficacy and anxiety sensitivity on worry.

Recent research has found low levels of general self-efficacy (GSE: beliefs about the ability to appropriately handle a wide range of stressors) and high levels of anxiety sensitivity (AS: fear of the negative consequences of experiencing anxiety) to be relevant predictors of pathological worry. This study examined the role of psychological inflexibility (PI: the dominance of private experiences over chosen values and contingencies in guiding action), the central component of the acceptance and commitment therapy model of psychopathology, in the effect of GSE and AS on worry. A total of 132 nonclinical participants completed questionnaires assessing the constructs of interest. Partial correlations and regression analyses showed that both GSE and AS were independent predictors of pathological worry after controlling for each other. However, mediation analyses revealed that psychological inflexibility completely mediated the independent effects of both GSE and AS on pathological worry. Theoretical and treatment implications of the results are discussed.

Anxiety Sensitivity and Alexithymia as Mediators of Postconcussion Syndrome Following Mild Traumatic Brain Injury

To examine the influence of anxiety sensitivity (AS) and alexithymia as potential mediators for the development of psychological distress and postconcussion syndrome after mild traumatic brain injury (mTBI). Sixty-one patients with mTBI assessed at a mean of 2.38 weeks after injury and demographically matched healthy controls (n = 61). Twenty-item Toronto Alexithymia Scale, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Rivermead Post Concussion Questionnaire. The mTBI group reported significantly higher levels of AS, alexithymia, psychological distress, and postconcussion (PC) symptom scores than controls. High AS and alexithymia in the mTBI group were associated with a greater number of PC symptoms and higher levels of psychological distress than patients scoring low on these measures and controls. In the mTBI group, a combination of AS and low mood explained 52.6% of the variance in PC symptom reporting. A combination of trait-anxiety, alexithymia, and PC symptoms explained 77.2% of the variance in levels of mood. A combination of low mood and high AS may act as a psychological diathesis for the development of persisting PC symptoms. Early identification could provide a focus for early intervention to prevent the development of postconcussion syndrome after mTBI.

Risk and resiliency in posttraumatic stress disorder: Distinct roles of anxiety and disgust sensitivity.

Although anxiety sensitivity and disgust sensitivity have been shown to predict adverse reactions to traumatic events, it remains unclear whether these traits are best conceptualized as risk or resilience factors for posttraumatic stress disorder (PTSD). In the present study, veterans with PTSD (n 21), trauma-exposed veterans without PTSD (n 16), and healthy nonveteran controls (n 22) completed measures of anxiety sensitivity, disgust sensitivity, and emotion regulation. The findings showed that veterans with PTSD reported significantly higher levels of anxiety sensitivity than veterans without PTSD and healthy nonveteran controls. However, veterans without PTSD and healthy nonveteran controls did not significantly differ in anxiety sensitivity. In contrast, veterans without PTSD reported significantly lower disgust sensitivity than veterans with PTSD and healthy nonveteran controls. Furthermore, veterans with PTSD and healthy nonveteran controls did not significantly differ from each other in disgust sensitivity. These distinct patterns of differences in anxiety sensitivity and disgust sensitivity remained significant when controlling for group differences in expressive emotion suppression. These preliminary findings suggest that anxiety sensitivity and disgust sensitivity may differ in the extent to which they represent risk or resilience factors for the development of PTSD.

Postoperative Pain in Children: Association Between Anxiety Sensitivity, Pain Catastrophizing, and Female Caregivers' Responses to Children's Pain

This study investigated the association between anxiety sensitivity and pain catastrophizing in children, caregivers' anxiety sensitivity and catastrophizing about children's pain and responses to children's pain, pain intensity reported by children, and pain intensity estimated by caregivers. The participants were 102 children scheduled for outpatient surgery and their female caregivers. Before the operation, caregivers' catastrophizing about children's pain, children's pain catastrophizing, and their anxiety sensitivity were assessed, as well as caregivers' responses to children's pain. Pain intensity reported by children and estimated by caregivers was evaluated after the operation and 24 hours afterward. Analyses were performed via path analysis. The results indicated that children and caregivers characterized by higher levels of anxiety sensitivity reported higher levels of pain catastrophizing and catastrophic thinking about children's pain, respectively. Caregivers with higher levels of catastrophic thinking about the children's pain reported higher levels of solicitousness and higher estimations of the children's pain intensity after the operation. Higher levels of children's pain catastrophizing were associated with more frequent responses of discouragement and higher pain intensity reported after the operation. These findings highlight the relevance of catastrophizing about children's pain and children's pain catastrophizing in the experience of postoperative pain in children. PerspectivePath analysis was used to test a hypothetical model of the associations between anxiety sensitivity, catastrophizing, parental responses, and postoperative pain in children. The results highlight the association between children's and parents' pain catastrophizing and discouragement and solicitous responses and the role of anxiety sensitivity as a traitlike factor associated with catastrophizing.

Emotional reasoning and anxiety sensitivity: Associations with social anxiety disorder in childhood

BackgroundTwo specific cognitive constructs that have been implicated in the development and maintenance of anxiety symptoms are anxiety sensitivity and emotional reasoning, both of which relate to the experience and meaning of physical symptoms of arousal or anxiety. The interpretation of physical symptoms has been particularly implicated in theories of social anxiety disorder, where internal physical symptoms are hypothesized to influence the individual's appraisals of the self as a social object. MethodThe current study compared 75 children on measures of anxiety sensitivity and emotional reasoning: 25 with social anxiety disorder, 25 with other anxiety disorders, and 25 nonanxious children (aged 7–12 years). ResultsChildren with social anxiety disorder reported higher levels of anxiety sensitivity and were more likely than both other groups to view ambiguous situations as anxiety provoking, whether physical information was present or not. There were no group differences in the extent to which physical information altered children's interpretation of hypothetical scenarios. LimitationsThis study is the first to investigate emotional reasoning in clinically anxious children and therefore replication is needed. In addition, those in both anxious groups commonly had comorbid conditions and, consequently, specific conclusions about social anxiety disorder need to be treated with caution. ConclusionThe findings highlight cognitive characteristics that may be particularly pertinent in the context of social anxiety disorder in childhood and which may be potential targets for treatment. Furthermore, the findings suggest that strategies to modify these particular cognitive constructs may not be necessary in treatments of some other childhood anxiety disorders.

The Association of Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate With Anxiety Sensitivity and Electronic Diary Negative Affect Among Smokers With and Without Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is associated with increased smoking initiation, maintenance, and relapse. Dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) are neurosteroids that have been associated with mood measures as well as smoking status, and nicotine is associated with increased DHEA and DHEAS levels. Given the difficulties with mood experienced by smokers with PTSD, the purpose of the current study was to evaluate the association between negative affect and anxiety sensitivity with DHEA and DHEAS levels. Ninety-six smokers with and without PTSD provided blood samples for neurosteroid analyses and completed self-report measures of anxiety sensitivity and electronic diary ratings of negative affect. As expected, PTSD smokers reported higher levels of anxiety sensitivity (F(1,94) = 20.67, partial η2 = 0.18, P < 0.0001) and negative affect (F(1,91) = 7.98, partial η2 = 0.08, P = 0.006). After accounting for age and sex, DHEAS was significantly inversely associated with both anxiety sensitivity (F(3,92) = 6.97, partial η2 = 0.07, P = 0.01) and negative affect (F(3,87) = 10.52, partial η2 = 0.11, P = 0.002) across groups. Effect sizes indicated that these effects are moderate to high. No significant interactions of diagnosis and DHEA(S) levels with mood measures were detected. Given that nicotine is known to elevate DHEA(S) levels, these results suggest that DHEAS may serve as a biomarker of the association between mood and nicotine among smokers. Implications for the results include (1) the use of DHEAS measurement across time and across quit attempts and (2) the potential for careful use of DHEA supplementation to facilitate abstinence during smoking cessation.

Anhedonia and Anxiety Sensitivity: Prospective Relationships to Nicotine Withdrawal Symptoms During Smoking Cessation

The aim of the present investigation was to explore the main and interactive effects of anhedonic depressive symptoms and anxiety sensitivity in terms of the individual components of nicotine withdrawal symptoms experienced on quit day as well as throughout the initial 14 days of cessation. Participants included 65 daily cigarette smokers (38 women; Mage = 46.08 years, SD = 9.12) undergoing psychosocial-pharmacological cessation treatment. Results indicated that, after controlling for the effects of participant sex and nicotine dependence, anhedonic depression symptoms, but not anxiety sensitivity, significantly predicted quit day levels of mood-based nicotine withdrawal symptoms. Conversely, anxiety sensitivity, but not anhedonic depression symptoms, was significantly related to the change in most nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between anxiety sensitivity and anhedonic depression symptoms related to the slope of certain withdrawal symptoms over time. Specifically, among participants with higher levels of anxiety sensitivity, greater levels of anhedonic depression symptoms were related to greater increases in withdrawal symptoms over time for two of the nine anxiety-relevant components of nicotine withdrawal (restlessness and frustration). Among high anxiety-sensitivity persons, compared with those low in anxiety sensitivity, anhedonic depression symptoms may be more relevant to the experience of some withdrawal symptoms being more intense and persistent during the early phases of quitting.

The Association between Cannabis Use, Mental Illness, and Suicidal Behavior: What is the Role of Hopelessness?

Cannabis is one of the most common illegal psychoactive substance used in European countries, in particular among adolescents and young adults (1). It has been estimated that almost 55% of adolescents aged 15–19 years have used cannabis at least once in their lifetime (2), while past year use is reported by approximately 30% of 15–17 year olds and over 47% of those aged 18–19 years (3). Cannabis use has been associated with several adverse life outcomes including unemployment, legal problems, dependence, early school leaving, increased risk of developing both psychotic and affective disorders (3, 4) together with brain structural and functional abnormalities (5, 6). An association between cannabis use, psychiatric disorders and suicidal behavior has also frequently been reported, although the exact nature of this link is still poorly understood (4). Globally, suicide is one of the most common causes of death among young people aged 10–24 years (6% of deaths), exceeded only by motor vehicle accidents (10%) (7). Over the last decade suicidal behavior has increased among adolescents and young adults, there has also been a trend toward the earlier initiation of cannabis use (8). This has led researchers to investigate the associations between the two factors to determine if cannabis use may be considered a factor that can trigger suicidal behavior. Evidence indicates that cannabis use is significantly associated with both attempted and completed suicides among healthy youths (9) and both twin studies (10) and case-control comparisons (11) have shown the increased risk of suicide ideation/attempts in those who use cannabis. Moreover, a longitudinal study found that frequent cannabis use (at least several times a week) predicted later suicidal ideation in susceptible males but not females (12). The earlier that this intense use first occurred and the higher the frequency of cannabis use, faster the susceptible individuals experienced suicidal thoughts. Frequent and early cannabis use has also been associated with impaired mental wellbeing among young individuals (13, 14), and the risk of developing psychiatric conditions such as psychosis (15) and major affective disorders (16). Specifically, evidence suggests that cannabis use may exacerbate pre-existing conditions such as bipolar disorder, and predict negative outcomes and psychosocial impairment (17, 18). According to longitudinal studies, the high and frequent use of cannabis is also associated with longer recovery times for affective conditions, more hospitalizations, poorer compliance with treatment, increased aggression, and poorer response to treatment in patients with bipolar disorder type I and II (12, 17). Nevertheless, it is important to note that many of the studies investigating associations between cannabis use and psychiatric conditions are cross-sectional in nature and cannot establish a causal relationship between the two phenomena (19). Further, several studies (20, 21) suggest a bidirectional relationship, as cannabis use variables do not solely explain the psychiatric outcomes observed nor do pre-existing psychiatric conditions fully explain the increased use of cannabis. Some researchers (22) have suggested that individuals with high levels of anxiety sensitivity or hopelessness may be more sensitive to the negative reinforcement processes of substance use (i.e., the ability of substances to modulate negative affective states) than non-affected individuals; however, some individuals experiencing the onset of mania or depression are not more likely to report increased cannabis use than those not experiencing these disorders (23, 24). In addition, other authors (25) have questioned the hypothesis that individuals may use cannabis to self-medicate psychotic or depressive symptoms. In summary, cannabis use may be considered only as a risk factor, and possibly one of a great many that may predict the onset or exacerbation of affective disorders and suicidal behavior (26). Thus, whether cannabis use can trigger psychiatric disorders or only precipitate or exacerbate psychiatric conditions in vulnerable individuals, is still poorly understood.

Trajectories of Perceived Emotional and Physical Distress in Patients with an Implantable Cardioverter Defibrillator

Little is known about the course of emotional and physical distress in patients with an implantable cardioverter defibrillator (ICD). We examined (1) trajectories of emotional and physical distress in the first 18 months postimplantation and (2) predictors of these trajectories, including demographical, clinical, and personality factors. Dutch patients with an ICD (N = 645) completed measures on anxiety, depression, somatic symptoms, and perceived disability at the time of implantation, and 2, 12, and 18 months postimplantation. Measures on Type D personality (tendency to inhibit the expression of negative emotions) and anxiety sensitivity (tendency to fear anxiety-related sensations) were also completed at baseline. Latent class analysis (LatentGOLD) identified six to seven distinct trajectories, varying largely in overall levels of distress, and remaining relatively stable after a small initial decline. Multinomial regression showed that Type D personality and anxiety sensitivity were the most prominent predictors, particularly of trajectories that reflected higher distress levels. Cardiac resynchronization therapy and coronary artery disease also increased the risk for distress, whereas ICD indication and shocks did not. The course of emotional and physical distress may be relatively stable after ICD implantation. In clinical practice, identification of patients with high risk of higher levels of emotional and physical distress may be warranted; as such, patients with high levels of anxiety sensitivity or a Type D personality should be identified and offered behavioral support.

Clarifying the Link Between Distress Intolerance and Exercise: Elevated Anxiety Sensitivity Predicts Less Vigorous Exercise

Anxiety sensitivity, one measure of distress intolerance, has been increasingly shown to play a role in a variety of health behaviors. A number of reports now suggest that individuals with higher levels of anxiety sensitivity (AS) are less likely to engage in exercise. However, this finding has been inconsistent across sex and limited by measurement strategy. This study examined the relationship between AS and self-reported exercise in a mixed-sex sample of 233 individuals. Consistent with prediction, AS was negatively associated with engagement in vigorous-intensity exercise; however, the strength of this association when covarying for sex was dependent on the measurement strategy used (continuous vs. categorical ASI scores). Sex did not moderate the AS-vigorous exercise association. AS was not associated with moderate-intensity exercise or walking. Results suggest a role of distress intolerance in exercise behavior and confirm the importance of continued research on this topic.

Anxiety and smoking cessation outcomes in alcohol-dependent smokers

Anxiety-related characteristics, including anxiety sensitivity and trait anxiety, are elevated in individuals with alcohol and nicotine dependence and associated with greater difficulties with quitting smoking. However, little is known about how anxiety-related characteristics are related to smoking cessation outcomes in alcohol-dependent smokers. The present study, part of a larger smoking cessation clinical trial, examined associations between anxiety sensitivity, trait anxiety, nicotine withdrawal symptoms, smoking urges, and smoking cessation outcomes in a sample of 83 alcohol-dependent smokers. Participants were enrolled in concurrent alcohol and tobacco treatment as part of a substance-abuse intensive outpatient program. Smoking cessation treatment was administered in a 3-week cognitive-behavioral format that included 8 weeks of open-label nicotine patch treatment. Information on nicotine withdrawal, smoking urges, and CO-confirmed smoking consumption rates was collected at baseline, quit date, end of behavioral treatment, and at a 1-month follow-up. Higher levels of anxiety sensitivity were associated with more smoking urges due to anticipation of negative affect relief at quit date. Higher levels of trait anxiety were associated with more smoking urges due to positive reinforcement and anticipation of relief of negative affect at quit date, as well as more severe nicotine withdrawal symptoms at the end of treatment. Levels of anxiety sensitivity and trait anxiety were not associated with Cox regression survival times to relapse. These results indicate that for alcohol-dependent smokers, levels of anxiety sensitivity and trait anxiety are important to consider in the assessment and treatment of nicotine dependence.

Prospective evaluation of the effects of anxiety sensitivity and state anxiety in predicting acute nicotine withdrawal symptoms during smoking cessation.

The current investigation explored the main and interactive effects of anxiety sensitivity (AS) and state anxiety in predicting acute nicotine withdrawal symptoms experienced during the initial 14 days of smoking cessation. Participants included 123 adult daily smokers (84 women; Mage = 45.93 years, SD = 10.34) undergoing psychosocial-pharmacological cessation treatment. Results indicated that after controlling for the effects of participant sex and nicotine dependence, state anxiety but not AS significantly predicted initial levels of nicotine withdrawal symptoms. Results also demonstrated that both state anxiety and AS were significantly related to the change in nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between AS and state anxiety. Specifically, higher levels of AS were associated with a stronger relation between state anxiety and nicotine withdrawal symptoms experienced during the cessation attempt. Results suggest that among high AS persons, state anxiety may be more relevant, compared to those low in AS, in regard to experiencing withdrawal symptoms as more intense during the early phases of quitting.

CCK-B receptor gene and response to cholecystokinin-tetrapeptide in healthy volunteers

Recent investigations suggest that genes that confer risk for panic disorder (PD) may moderate response to panicogenic agents in healthy volunteers. Given the potential role of the central cholecystokinin receptor (CCKBR) (CT) polymorphism alleles 26 and 27 in PD, the present study attempted to discern if these alleles moderated panicogenic sensitivity to the CCKBR agonist, CCK-tetrapeptide (CCK-4), in healthy volunteers. The study group consisted of 92 men and women with no personal or family history of psychiatric illness. Participants provided blood samples for genotyping of the CCKBR alleles and they received a 25μg bolus injection of CCK-4. Behavioral, cardiovascular and hormonal responses to the peptide were assessed and analyzed with adjusted linear regression models. Carriers of the CCKBR alleles tended to have higher levels of pre-challenge anxiety and significantly higher levels of anxiety sensitivity and introversion than those without the alleles. However, they did not exhibit an enhanced panicogenic response to CCK-4. Overall, our findings do not demonstrate a role of these alleles in modulating CCK-4's panicogenicity. The significant association between the risk alleles and anxiety-related personality traits is intriguing and further exploration of this association is merited.