Treatment-seeking Adults Research Articles

Intolerance of uncertainty and repetitive negative thinking: transdiagnostic moderators of perfectionism in eating disorders

Perfectionism has been identified as a vulnerability and maintenance factor across eating disorders (EDs). Additionally, research has found that intolerance of uncertainty (IU) and repetitive negative thinking (RNT) moderate the relationship between perfectionism and psychopathology. Despite this evidence, few studies have examined if these factors specifically moderate ED severity. This study aimed to fill this gap by investigating the moderating effect of IU and RNT on the relationship between perfectionism and ED symptoms, as well as the predictive power of these factors on identifying participants with clinically significant ED symptoms. 331 treatment-seeking adults from a university-affiliated community clinic and 264 undergraduate students completed measures to assess ED symptoms, RNT, perfectionism and IU. 147 participants (24.7% of the total sample) had clinically significant levels of ED symptoms as determined by the Eating Disorder Questionnaire Short-Form (EDE-QS). Multiple linear regressions found significant associations between ED symptoms and both the IU*perfectionism interaction (p < .001) and the RNT*perfectionism interaction (p < .001). A binary logistic regression identified that both the IU*perfectionism interaction (p = .03) and the RNT*perfectionism interaction (p = .001) predicted clinically significant EDE-QS scores. The findings indicate that both IU and RNT moderate the relationship between perfectionism and ED symptoms and build on previous literature recognising transdiagnostic contributors to ED symptomatology.

Rasch analysis of the depression anxiety stress scales-21 (DASS-21) in a mild traumatic brain injury sample.

In this study, we evaluated the psychometric properties of the Depression Anxiety Stress Scales 21 items (DASS-21) in a mild traumatic brain injury (mTBI) sample. Treatment-seeking adults (n = 347) were recruited from outpatient rehabilitation services in New Zealand. Dimensionality, reliability, person separation index, and differential item functioning (DIF) of the DASS-21 were examined using Rasch analysis. Initial analysis of the complete 21-item DASS showed poor overall fit due to problems with individual items. Fit to the Rasch model was excellent when treated as three composite scores. The stress subscale demonstrated adequate model fit, dimensionality and good reliability. For anxiety, fit was not good, reliability was unsatisfactory and DIF was evident on one item. When this item was removed, fit to the model was still inadequate as was reliability. DIF was also evident for depression, but when this item was removed, fit to the model was adequate. The DASS-21 is a psychometrically sound measure of distress and stress for adults seeking treatment following mTBI. Ordinal to interval score conversion tables are provided to increase the precision of measurement. When assessing depression in a mTBI population, a 6-item depression subscale is recommended. Caution is advised in using the DASS-21 anxiety subscale alone.

Clinical characteristics of a treatment seeking sample of adults with misophonia: Onset, course, triggers, context, and comorbidity

Misophonia is characterized by intense emotional reactions to specific repetitive sounds. The clinical characteristics and developmental course of misophonia remain underexplored, particularly in treatment-seeking adults. In this study, we characterized the onset, symptom progression, trigger noises, and psychiatric comorbidities associated with misophonia. Additionally, we investigated the relationships between these clinical attributes and the severity of self- and clinician-rated misophonia symptoms. The sample included 60 adults with misophonia enrolled in a randomized controlled trial. Most participants (79%) reported symptom onset in childhood and early adolescence, with symptoms often worsening over time. All participants reported being bothered by human produced sounds. However, responses to trigger noises vary based on the context surrounding the sound. Those who reported equivalent distress across misophonic triggers –regardless of the individual producing the sound—endorsed significantly higher self-reported misophonia symptoms. Approximately half of the sample met diagnostic criteria for another psychiatric condition, with attention-deficit hyperactivity disorder and generalized anxiety disorder being the most prevalent. These findings underscore the complexity of misophonia and highlight the importance of considering the individual clinical histories and contextual factors influencing reactions to misophonic sounds.

Effects of behavioral interventions on stress reactivity in adults with substance use disorders.

Heightened reactivity to stress is associated with poor treatment outcome in people with substance use disorders (SUDs). Behavioral strategies can reduce stress reactivity; however, these strategies are understudied in people with SUDs. The objective of this study was to test the effect of two behavioral strategies (cognitive reappraisal and affect labeling) on stress reactivity in people with SUDs. Treatment-seeking adults with SUDs (N = 119) were randomized to receive brief training in cognitive reappraisal, affect labeling, or a psychoeducational control, followed by a standardized stress induction. Markers of stress reactivity were collected before and following stress induction and included self-reported negative affect and substance craving, as well as salivary cortisol, and skin conductance response. Analyses of covariance did not indicate a significant effect of treatment condition on negative affect, cortisol, or skin conductance response. Participants in the affect labeling condition had greater increase in craving than those in the cognitive reappraisal condition; neither condition differed from control. Results indicated that, although participants were able to implement behavioral skills following a brief training, training condition did not modify stress reactivity, on average, relative to control. Future directions include consideration of individual differences in response to training and determination of whether higher "dosing" of skills via multiple sessions or extended practice is needed to influence stress reactivity in people with SUDs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Digital Cognitive Behavioral Therapy Program for Adults With Alcohol Use Disorder

Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use, yet patient access is limited and may be enhanced through digital therapeutics. To evaluate the efficacy of a digital CBT program (Computer-Based Training for Cognitive Behavioral Therapy [CBT4CBT]) or clinician-delivered CBT compared with standard treatment for reducing alcohol use. A 3-arm randomized clinical trial was conducted at outpatient substance use treatment facilities in Connecticut between February 14, 2017, and December 31, 2021, that included an 8-week treatment period with a 6-month follow-up period. Treatment-seeking adults were included who met criteria for current alcohol use disorder and reported drinking at least 14 (men) or 7 (women) drinks per week in the past month and were sufficiently stable for outpatient treatment. Participants were randomly assigned to 1 of the following groups: (1) treatment as usual (TAU) consisting of weekly group or individual counseling, (2) CBT delivered weekly by trained and fidelity-monitored clinicians, or (3) web-based CBT plus brief weekly clinical monitoring. Rates of alcohol use were measured weekly during the treatment period and at 1-, 3-, and 6-month follow-up using the timeline follow-back method. The primary outcome was the percentage of days abstinent (PDA) from alcohol per month. Intention-to-treat analyses were conducted. Of the 99 randomized participants (mean [SD] age, 45.5 [12.7]), 66 were male (66.7%); 39 identified as Black/African American (39.8%), 19 (19.2%) as Hispanic, and 47 (48.0%) as White. Mean (SD) rates of PDA from baseline to 6-month follow-up were 49.3% (27.8%) to 69.6% (34.4%) for TAU; 53.7% (29.8%) to 70.2% (35.1%) for CBT; and 47.6% (31.8%) to 82.6% (25.3%) for digital CBT. Results of random-effects regression showed a significant increase in PDA during the study period, with those assigned to digital CBT increasing PDA at a faster rate than TAU (t733 = 2.55; P = .01) and CBT (t733 = 3.36; P < .001). However, there was no statistically significant difference between treatment groups during the 8-week treatment period. In this randomized clinical trial, while there was no significant difference between treatment groups during the 8-week treatment period, there was differential change between treatments during the 8-month study period that provides support for the efficacy of this digital CBT program. ClinicalTrials.gov Identifier: NCT02742246.

Exploring the Utility of a Functional Magnetic Resonance Imaging Cannabis Cue-Reactivity Paradigm in Treatment-Seeking Adults With Cannabis Use Disorder

BackgroundFunctional magnetic resonance imaging studies examining cue reactivity in cannabis use disorder (CUD) either have had small sample sizes or have involved non–treatment-seeking participants. As a secondary analysis, we administered a functional magnetic resonance imaging cue-reactivity task to participants with CUD enrolled in 2 separate clinical trials (varenicline or repetitive transcranial magnetic stimulation) to determine the task activation patterns for treatment-seeking participants with CUD. We aimed to determine the activation patterns for the total sample and behavioral correlates. We additionally compared studies to determine if patterns were consistent. MethodsTreatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline using the Marijuana Craving Questionnaire–Short Form and completed a visual cannabis cue-reactivity task during functional magnetic resonance imaging (measuring the blood oxygen level–dependent response) following 24 hours of cannabis abstinence. ResultsThe sample included 65 participants (n = 37: varenicline trial; n = 28: repetitive transcranial magnetic stimulation trial; 32% female; mean age = 30.4 ± 9.9 years). When comparing cannabis images versus matched neutral images, participants showed greater blood oxygen level–dependent response in bilateral ventromedial-prefrontal, dorsolateral-prefrontal, anterior cingulate, and visual cortices as well as the striatum. There was stronger task-based functional connectivity between the medial prefrontal cortex and both the amygdala and the visual cortex. Craving negatively correlated with blood oxygen level–dependent response in the left ventral striatum (R2 = −0.32; p = .01) in the full sample. There were no significant differences in either activation or task-based functional connectivity between studies. ConclusionsIn 2 separate treatment-seeking groups with CUD, there was increased cannabis cue reactivity and task-based functional connectivity in regions related to executive function and reward processing. Cannabis craving was negatively associated with cue reactivity in the left ventral striatum.

Undervaluing nondrug rewards or overvaluing cocaine? Cocaine demand relates to cocaine use severity more strongly than anhedonia in individuals with cocaine use disorder.

Cocaine use disorder (CUD) is a major public health issue, and greater cocaine use severity has been associated with worse treatment retention and outcomes. Therefore, greater understanding of processes that influence cocaine use is needed. Both anhedonia (i.e., undervaluation of nondrug rewards) and cocaine demand (i.e., cocaine valuation) are related to cocaine use severity and thematically related to each other at face value, but no studies have directly compared these outcomes to our knowledge. The present study represents a secondary analysis from a two-phase sequential, multiple assignment, randomized trial aimed at developing adaptive interventions for CUD. We examined the relationship between anhedonia and cocaine demand and how these measures were related to cocaine use severity. Participants (N = 116) were treatment-seeking adults with CUD. All measures were taken at baseline before treatment initiation. Analyses revealed (a) moderate and very strong evidence of relationships between cocaine demand factors (i.e., persistence, amplitude) and anhedonia (PP values ≥ 77.8%); (b) positive association between cocaine demand (both persistence and amplitude) and measures of cocaine use severity, with the exception of one relationship, which was in the opposite direction; and (c) demand amplitude continued to be positively related to cocaine use severity, even when considering anhedonia. Overall, findings from this study indicate cocaine demand relates to cocaine use severity more strongly than anhedonia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Validation of a laboratory craving assessment and evaluation of 4 different interventions on cravings among adults with overweight or obesity

Food cue reactivity (FCR) is an appetitive trait associated with overeating and weight gain. We developed a laboratory craving assessment to objectively evaluate cognitive aspects of FCR. This study examined the preliminary construct and criterion validity of this craving assessment and evaluated 4 different interventions, 2 of which incorporated cue-exposure treatment for food, on craving over treatment and follow-up. 271 treatment-seeking adults with overweight/obesity (body mass index = 34.6[5.2]; age = 46.5[11.8]; 81.2% female; 61.6% non-Latinx White) completed the Food Cue Responsivity Scale and the laboratory craving assessment, during which they alternated holding and smelling a highly craved food and provided craving ratings over 5 min. Participants were subsequently randomized to 26 treatment sessions over 12-months of ROC, Behavioral Weight Loss (BWL), a combined arm (ROC+) and an active comparator (AC), and repeated the craving assessment at post-treatment and 12-month follow-up. Linear mixed-effects models assessed associations between trial type (holding vs. smelling), trial number, pre-treatment FCR, treatment arm, assessment time point, and craving. Cravings were greater when smelling vs. holding food (b = 0.31, p < 0.001), and cravings decreased over time (b = −0.02, p < 0.001). Participants with higher pre-treatment FCR reported elevated cravings (b = 0.29, p < 0.001). Longitudinally, we observed a significant 3-way interaction in which treatment arm modified the relationship between pre-treatment FCR and craving over time (F(17,5122) = 6.88, p < 0.001). An attenuated FCR-craving relationship was observed in ROC+ and BWL from baseline to post-treatment but was only sustained in BWL at follow-up. This attenuation was also observed in ROC and AC from post-treatment to follow-up. The preliminary validity of this laboratory craving assessment was supported; however, greater craving reductions over time in ROC/ROC+ compared to BWL and AC were not consistently observed, and thus do not appear to fully account for the moderating effect of FCR on weight losses observed in the trial.

Withdrawal interference scale: a novel measure of withdrawal-related life disruption in opioid use disorder and alcohol use disorder

ABSTRACT Background: Hyperkatifeia describes amplified emotional and motivational withdrawal due to addiction-related sensitization of brain-stress-systems. Hyperkatifeia has been proposed as a target for addiction treatment development. However, translation of basic research in this area will require new tools designed to measure hyperkatifeia and related phenomena outside of laboratory settings. Objectives: We define a novel concept, withdrawal interference, and introduce a new tool – the Withdrawal Interference Scale (WIS) – which measures the impact of withdrawal on daily life among individuals with OUD or AUD. Methods: Described are the combined results of three separate cross-sectional studies. The structural validity, convergent validity, construct validity, trans-diagnostic (AUD/OUD) configural, metric, and scalar invariance, internal consistency, and composite reliability of WIS was tested among three independent samples of 1) treatment-seeking adults with OUD (n = 132), 2) treatment-seeking adults with AUD (n = 123), and 3) non-treatment-seeking adults with OUD (n = 140). Males numbered 218 and females were 163. Results: WIS exhibited structural validity (1 factor), convergent validity (average variance extracted .670–.676), construct validity, trans-diagnostic configural (χ2/df = 2.10), metric (Δχ2 = 5.70, p = .681), and scalar invariance (Δχ2 = 12.34, p = .338), internal consistency (α .882–928), and composite reliability (.924–.925). Conclusion: These results suggest WIS is a valid and reliable instrument for measuring withdrawal-related life disruption in AUD and OUD. Further, given our findings of transdiagnostic measurement invariance, WIS scores of individuals with AUD and OUD can be meaningfully compared in future statistical analyses.

A naturalistic examination of feeling fat: Characteristics, predictors, and the relationship with eating disorder behaviors.

Although literature implicates feeling fat in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa, binge-ED), research in this area is small, nascent, and relies on retrospective self-report. The current study sought to understand the temporal pattern of feeling fat and its role as a precipitant and consequence of ED behaviors. Totally 106 treatment-seeking adults with binge-spectrum EDs completed 7-14-day ecological momentary assessments. They rated feeling fat, negative affect states, and reported on ED behaviors six times per day. Multilevel models evaluated whether feeling fat mediates prospective links between negative affect states and ED behaviors, assessed if negative affect states mediate the prospective association of feeling fat on ED behaviors, and examined the bidirectional prospective association between feeling fat and ED behaviors. Feeling fat was highest in the early morning (6-8:59 a.m.). Individuals with binge-ED-spectrum EDs demonstrated greater variability in feeling fat than those with bulimia nervosa-spectrum EDs who had stable and high levels of feeling fat. Guilt, sadness, anxiety, and the overall NA at Time 2 mediated the prospective associations between at Time 1 feeling fat and Time 3 dietary restraint, actual dietary restriction, and compensatory exercise. There was a bidirectional prospective association between feeling fat and binge eating. Feeling fat serves as a proximal predictor and mediator of the prospective association between guilt and binge eating. Feeling fat and binge eating mutually reinforce each other. Little is understood regarding the experience of feeling fat in natural environments among individuals with binge-spectrum eating disorders. We found that the risk for having the experience of feeling fat is high in the morning and evening. Feeling fat triggers guilt, anxiety, and sadness which in turn, increases engagement in dietary restraint/restriction and compensatory exercise. Feeling fat also triggers binge eating, and binge eating leads to feelings of fatness.

Early life stress is associated with greater negative emotionality and peripheral inflammation in alcohol use disorder

Early life stress (ELS) increases risk for psychiatric illness, including alcohol use disorder (AUD). Researchers have hypothesized that individuals with and without a history of ELS who have the same primary DSM-5 diagnosis are clinically and biologically distinct. While there is strong support for this hypothesis in the context of mood disorders, the hypothesis remains largely untested in the context of AUD. This study investigated the impact of ELS on the neuroclinical phenomenology and inflammatory profile of individuals with AUD. Treatment-seeking adults with AUD (N = 163) completed the Adverse Childhood Experiences (ACE) Questionnaire and phenotypic battery as part of a pharmacotherapy trial for AUD (NCT03594435). Participants were classified as having “no-ELS,” (ACE = 0) “moderate-ELS,” (ACE = 1, 2 or 3) or “high-ELS” (ACE = 4 + ). The Addictions Neuroclinical Assessment domains incentive salience and negative emotionality were derived and used to assess the neuroclinical phenomenology of AUD. We tested (1) cumulative ELS as a predictor of ANA domains and (2) ELS group differences in ANA domains. A subset of participants (N = 98) provided blood samples for a biomarker of peripheral inflammation (C-reactive protein; CRP); analyses were repeated with CRP as the outcome variable. Greater ELS predicted higher negative emotionality and elevated CRP, but not incentive salience. The high-ELS group exhibited greater negative emotionality compared with the no-ELS and moderate-ELS groups, with no difference between the latter two groups. The high-ELS group exhibited elevated CRP compared with the no/moderate-ELS group. Findings suggest that high-ELS exposure is associated with a unique AUD neuroclinical presentation marked by greater negative emotionality, and inflammatory profile characterized by elevated peripheral CRP.

Using Drift Diffusion and RL Models to Disentangle Effects of Depression On Decision-Making vs. Learning in the Probabilistic Reward Task.

The Probabilistic Reward Task (PRT) is widely used to investigate the impact of Major Depressive Disorder (MDD) on reinforcement learning (RL), and recent studies have used it to provide insight into decision-making mechanisms affected by MDD. The current project used PRT data from unmedicated, treatment-seeking adults with MDD to extend these efforts by: (1) providing a more detailed analysis of standard PRT metrics-response bias and discriminability-to better understand how the task is performed; (2) analyzing the data with two computational models and providing psychometric analyses of both; and (3) determining whether response bias, discriminability, or model parameters predicted responses to treatment with placebo or the atypical antidepressant bupropion. Analysis of standard metrics replicated recent work by demonstrating a dependency between response bias and response time (RT), and by showing that reward totals in the PRT are governed by discriminability. Behavior was well-captured by the Hierarchical Drift Diffusion Model (HDDM), which models decision-making processes; the HDDM showed excellent internal consistency and acceptable retest reliability. A separate "belief" model reproduced the evolution of response bias over time better than the HDDM, but its psychometric properties were weaker. Finally, the predictive utility of the PRT was limited by small samples; nevertheless, depressed adults who responded to bupropion showed larger pre-treatment starting point biases in the HDDM than non-responders, indicating greater sensitivity to the PRT's asymmetric reinforcement contingencies. Together, these findings enhance our understanding of reward and decision-making mechanisms that are implicated in MDD and probed by the PRT.

Neural Correlates of Stress and Alcohol Cue-Induced Alcohol Craving and of Future Heavy Drinking: Evidence of Sex Differences.

Stress and alcohol cue reactivity are associated with poor treatment outcomes in alcohol use disorder (AUD), but sex-specific neural correlates of stress and alcohol cue-induced craving compared with neutral cue-induced craving and of heavy drinking outcomes in AUD have not been examined. Thus, this study prospectively examined these associations and assessed sex differences. Treatment-seeking adults with AUD (N=77; 46 men and 31 women) completed a functional MRI task involving stress, alcohol, and neutral cue exposure with repeated assessments of alcohol craving. Most of these participants (N=72; 43 men and 29 women) then participated in an 8-week standardized behavioral AUD treatment program, during which the percentage of heavy drinking days was assessed. Significant increases in both stress and alcohol cue-induced craving relative to neutral cue-induced craving were observed, with a greater alcohol-neutral contrast in craving relative to the stress-neutral contrast among men and equivalent stress-neutral and alcohol-neutral contrasts in craving among women. Whole-brain voxel-based regression analyses showed craving-associated hyperactivation in the neutral condition, but hypoactive prefrontal (ventromedial and lateral prefrontal, supplementary motor, and anterior cingulate regions) and striatal responses during exposure to stressful images (stress-neutral contrast) and alcohol cues (alcohol-neutral contrast), with significant sex differences. Additionally, a higher percentage of heavy drinking days was associated with hypoactivation of the subgenual anterior cingulate cortex and the bed nucleus of the stria terminalis in the stress-neutral contrast among women, hyperactivation of the hypothalamus in the stress-neutral contrast among men, and hyperactivation of the hippocampus in the alcohol-neutral contrast among men. Sex differences in stress- and alcohol cue-induced responses in the cortico-striatal-limbic network related to subjective alcohol craving and to heavy drinking indicated that distinct brain circuits underlie alcohol use outcomes in women and men. These findings underscore the need for sex-specific therapeutics to address this neural dysfunction effectively.

Is There an Association Between Lateralization of Chronic Pain in the Body and Depression?

Depression commonly co-occurs with chronic pain and can worsen pain outcomes. Recent theoretical work has hypothesized that pain localized to the left hemibody is a risk factor for worse depression due to overlap in underlying neural substrates. This hypothesis has not been tested a priori. Using a large sample of treatment-seeking adults with mixed-etiology chronic pain (N = 1,185), our cross-sectional study tested whether patients with left-sided pain endorse worse depressive symptoms. We also examined differences in other pain-related functioning measures. We tested 4 comparisons based on painful body areas using the CHOIR body map: 1) only left-sided (OL) versus any right-sided pain; 2) only right-sided (OR) versus any left-sided pain; 3) OL versus OR versus bilateral pain; and 4) more left-sided versus more right-sided versus equal-sided pain. Analysis of variance models showed OL pain was not associated with worse depression (F = 5.50, P = .019). Any left-sided pain was associated with worse depression, though the effect was small (F = 8.58, P = .003, Cohens d = .29). Bilateral pain was associated with worse depression (F = 8.05, P < .001, Cohens d = .24–.33). Regardless of pain location, more body areas endorsed was associated with greater depression. Although a more rigorous assessment of pain laterality is needed, our findings do not support the hypothesis that left-lateralized pain is associated with worse depression. PerspectivePain lateralized to the left side of the body has been hypothesized as a risk factor for worse depression in chronic pain, despite never being tested in a large, real-world sample of patients with chronic pain. Findings showed that more widespread pain, not pain laterality, was associated with worse depression.

Associations between adverse childhood experiences and history of weight cycling.

Adverse childhood experiences (ACEs) predict obesity onset; however, the relationship between ACEs and history of weight cycling has not been adequately explored. This gap is problematic given the difficulty in weight loss maintenance and the impact of ACEs on obesity development, chronicity, and associated weight stigma. The objective of this study was to examine associations between self-reported history of ACEs and weight cycling in a sample of weight loss treatment-seeking adults with overweight/obesity. The number of participants in the analyzed sample was 78, mostly white educated adult women (80% female, 81% Caucasian, 75%≥bachelor's degree) with excess adiposity enrolled in the Cognitive and Self-regulatory Mechanisms of Obesity Study. ACEs were measured at baseline using the ACEs Scale. History of weight cycling was measured using the Weight and Lifestyle Inventory that documented weight loss(es) of 10 or more pounds. Higher ACE scores were associated with a greater likelihood of reporting a history of weight cycling. Participants with four or more ACEs had 8 times higher odds (OR=8.301, 95% CI=2.271-54.209, p=0.027) of reporting weight cycling compared with participants with no ACEs. The association of weight cycling for those who endorsed one to three ACEs was not significant (OR=2.3, 95% CI=0.771-6.857, p=0.135) in this sample. The role of ACEs in health may be related to associations with weight cycling. Results indicated that those who reported four or more ACEs had significantly higher odds of reporting weight cycling compared with those with no ACEs. Further research is needed to further explore how ACEs predict the likelihood of weight cycling, which may be prognostic for sustained weight loss treatment response and weight stigma impacts.

Cannabis use and binge eating: Examining the relationship between cannabis use and clinical severity among adults with binge eating.

Cannabis use is prevalent among individuals with binge eating (BE; i.e., the inability to control eating behavior). Yet, only two studies to date (both over 20 years old) have tested if cannabis use relates to clinical severity among BE samples. Characterizing the relationship between cannabis use, eating disorder (ED) severity, and other psychiatric symptoms in BE samples is necessary for informing screening and clinical recommendations. The present study characterized cannabis use among adults with BE and tested between-group and within-group relationships between cannabis use and eating disorder symptoms, alcohol consumption and symptoms, and depression symptoms. Participants (N = 165) were treatment-seeking adults with at least once weekly BE in the past 3 months who completed clinical interviews and self-report measures before treatment. Over 23% of participants reported cannabis use in the past 3 months, with most persons using cannabis reported using "once or twice" or "monthly." Most persons using cannabis reported cannabis-related symptoms. Persons using cannabis reported significantly greater alcohol consumption and were more likely to report alcohol-related symptoms compared to persons not using cannabis. No associations were observed between cannabis use, eating disorder symptoms, and depressions symptoms. These findings indicate that a notable subset of patients with BE use cannabis and experience cannabis-related problems, and that cannabis and alcohol use may be related for these individuals. Considering legal and sociocultural shifts in cannabis availability and prevalence, results from the present study support screening for cannabis and alcohol use patterns in patients with BE. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Anxiety sensitivity, finding the body, and posttraumatic stress disorder in suicide-bereaved treatment-seeking adults.

Those bereaved by suicide are at greater risk of prolonged distress compared to those bereaved by other modes of death. Trauma- and emotion-related factors may increase this vulnerability. Finding the body of the deceased may intensify postsuicide distress. Anxiety sensitivity, fear of one's anxiety-related symptoms, has been positively associated with posttraumatic stress disorder (PTSD) in other trauma populations but has not been studied in the suicide bereaved. This study examined the relationships among finding the body, anxiety sensitivity, and PTSD in a treatment-seeking, suicide-bereaved sample (N = 50). Pretreatment baseline data on demographics, the Anxiety Sensitivity Index, and the PTSD Checklist were analyzed. Younger age (r = -.31, p = .03), being a person of color (r = -.32, p = .02), and fewer days since the loss (r = -.30, p = .03) were associated with greater PTSD. Controlling for age, race, and days since the loss, PTSD was unrelated to finding the body, F(1, 45) = 0.01, p = .92, but was positively associated with anxiety sensitivity (pr = .32, p = .03). In simultaneous regression analyses, age, race, days since the loss, finding the body, and anxiety sensitivity accounted for 33% of the variance in PTSD, F(2, 44) = 4.29, p = .003; anxiety sensitivity was the only significant predictor of PTSD symptoms (β = .36, t = 2.35, p = .02). Anxiety sensitivity has important implications for the development and maintenance of PTSD in the suicide bereaved and should be assessed and targeted in suicide postvention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Course and clinical correlates of obsessive-compulsive disorder with or without comorbid personality disorder

BackgroundPersonality disorders (PDs) are often comorbid with obsessive-compulsive disorder (OCD) which may influence symptom presentation and course. This investigation sought to examine the impact of comorbid PDs on clinical presentation and symptom chronicity in a large, prospective longitudinal OCD study. MethodsParticipants (n = 263) were treatment-seeking adults with a primary diagnosis of OCD separated into two groups: individuals with and without a co-occurring PD. We conducted two-tailed t-tests to compare symptom severity, functioning, and quality of life between the OCD + PD group (n = 117) and the OCD w/o PD group (n = 146). Chronicity analyses were conducted to compare the amount of time in-episode for OCD and major depressive disorder (MDD) between the two groups. ResultsThe OCD + PD group reported greater OCD and depression severity, lower levels of psychosocial functioning and worse quality of life than the OCD w/o PD group. The OCD + PD group exhibited greater OCD and MDD symptom chronicity; over 5 years the OCD + PD group spent 16.2 % weeks longer at full criteria for OCD and three times as many weeks in episode for MDD than the OCD w/o PD group. LimitationsFocusing on PDs as a group limited our ability to make observations about specific PDs. Further, the participants in our sample were predominantly White and all were treatment seeking which limits the generalizability of our findings. ConclusionsOur results suggest that those with OCD and comorbid PDs present with greater overall impairment and may require additional considerations during treatment conceptualization and planning.

Associations among Trauma Exposure, Post-Traumatic Stress Symptoms and Alcohol Use in Black/African American Treatment-Seeking Adults

Objective Black/African American (AA) individuals are a group at risk for co-occurring posttraumatic stress disorder (PTSD) symptoms and alcohol use due to unique cultural and system-level barriers. Although associations between trauma exposure, PTSD symptoms, and alcohol use are well established across various populations, Black/AA individuals are underrepresented in this literature, and related findings in this population are inconclusive. Thus, the goal of this study was to examine the associations among trauma exposure, PTSD symptoms, and alcohol use in a sample of treatment-seeking, Black/AA adults. We hypothesized that trauma exposure and alcohol use would be positively associated and that this relationship would be mediated by PTSD symptoms. Methods This study conducted secondary analysis of screening data from a PTSD and alcohol use disorder clinical trial. Participants were 96 Black/AA adults (57.3% male; 2.0% Hispanic; M age = 44.73, SD = 11.83) who were seeking treatment for alcohol use and endorsed trauma exposure. Associations between trauma exposure, PTSD symptom severity, and quantity and frequency of alcohol use were tested using bivariate correlations and linear regressions. Hypothesized indirect effects were tested using IBM SPSS Statistics Version 27 PROCESS model 4 with bootstrapping. Results Findings illustrated a significant positive association between trauma exposure and PTSD symptoms and between PTSD symptoms and drinks per typical drinking day. PTSD symptoms were not significantly associated with number of drinking days. Tests of indirect effects were significant for trauma exposure on drinks per typical drinking day through PTSD symptoms. Conclusions Results from the test of indirect effects suggest that among Black/AA adults with heavy alcohol use and trauma exposure, trauma exposure is associated with PTSD symptoms, which in turn is associated with quantity of alcohol use. These findings are consistent with research conducted with White/mixed groups and align with tenets of the self-medication model of PTSD-AUD comorbidity. These findings support current practices that highlight the importance of screening for and addressing PTSD and alcohol use in individuals exposed to trauma. Findings from this paper provide initial data on understudied relationships in an underserved sample and several suggestions are made to generate future research and improve clinical care for Black/AA adults.

Latent classes of alcohol and cannabis use among adults with binge-spectrum eating disorders: Associations with eating disorder symptom severity and personality features.

Alcohol and cannabis use are prevalent among individuals with binge-spectrum eating disorders (B-ED) and vary in terms of frequency and associated problems. The current study aimed to identify latent classes of alcohol and cannabis use patterns among B-ED and examine associations between latent classes and demographic characteristics, eating disorder symptoms, and personality features. Participants (N=236) were treatment-seeking adults with B-ED who completed a clinical interview of eating pathology and self-report measures of alcohol and cannabis use in the past 3months, alcohol and cannabis-related problems, and personality features (i.e., impulsivity, affect lability). Latent class analysis identified three heterogeneous classes, labelled as (a) Low Alcohol, (b) Moderate Drinking and Problems with Occasional Cannabis Use, and (c) No Alcohol and Cannabis Use. Latent classes significantly differed in terms of substance use engagement and problems, demographic characteristics, dietary restraint, impulsive personality features, and affect lability. Study findings support heterogeneity in alcohol and cannabis use among B-ED and suggest patient characteristics and clinical severity associated with specific substance use presentations. Future research should replicate results using larger, diverse samples engaging in a broader range of alcohol and cannabis use symptoms.