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Background: Recent research implicates a potential relationship between poor distress tolerance (DT) and obsessive-compulsive disorder (OCD) and obsessions in particular, though this evidence has been largely indirect. We sought to examine the incremental and specific associations between DT and obsessions using multiple methodologies., Methods: We conducted three separate studies using independent nonclinical samples (total N=558) that involved cross-sectional (Study 1) and prospective self-report designs (Study 2), as well as the use of an in vivo neutralization task (Study 3)., Results: Poor DT was specifically associated with obsessing but not other OCD symptoms, even when covarying for several theoretically relevant constructs. Further, poor DT was predictive of residual change in obsessing symptoms 1-month later. Poor DT was also associated with neutralization in response to an OCD-like intrusion and postneutralization period anxiety., Conclusions: These consistent findings provide support for an important relationship between DT and obsessions and suggest that interventions targeting DT may have special benefit for the treatment of obsessions., (© 2011 Wiley-Liss, Inc.)

The present study examined the relations between posttraumatic stress disorder (PTSD) and cannabis use in a large representative survey of adults (N = 5,672) from the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (i.e., age, marital status, ethnicity, education, income, and sex), alcohol use disorders, and nicotine dependence, lifetime and current (past year) PTSD diagnoses were associated with increased odds of lifetime history of cannabis use as well as past year daily cannabis use. Lifetime, but not current, PTSD diagnosis also was uniquely associated with increased risk for any past year cannabis use. Additional analyses revealed that the relations between PTSD (lifetime and current) and lifetime cannabis use remained statistically significant when adjusting for co-occurring anxiety and mood disorders and trauma type frequency. Overall, these findings add to the emerging literature demonstrating a possibly important relationship between PTSD and cannabis use., ((c) 2011 APA, all rights reserved.)

Recent research suggests that obsessive-compulsive washers are more likely than individuals without washing compulsions to use conscious, internal reference criteria when deciding when to terminate compulsions (Wahl, Salkovskis, & Cotter, 2008). An alternative view is that they possess tendencies towards non-cognitive, automatic 'not just right' experiences (NJREs) that influence compulsion duration. The current study sought to investigate the latter explanation using valid behavioral tasks. Non-clinical participants (N=133) completed self-report measures, immersed their hands in a dirt mixture, and afterwards were allowed to wash their hands. Additionally, a subset of participants completed an in vivo assessment of NJRE using a pile of clutter. Total number and intensity of NJREs were predictive of hand-washing duration. Additionally, affective response to the clutter was uniquely predictive of hand-washing duration when controlling for pre-wash anxiety. These results suggest that internal reference criteria as well as NJREs may influence compulsive washing, though the former may be a consequence of the latter., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The current study examined the association between asthma and both smoking and nicotine dependence in the National Comorbidity Survey-Replication (NCS-R) as well as the temporal patterning between smoking and asthma onset (N = 5692; 53% female; M (age) = 45.01, SD = 17.9). Results indicated lifetime history of daily smoking and nicotine dependence were both significantly associated with asthma diagnosis and half of individuals with asthma reported that their asthma diagnosis preceded smoking onset. These data suggest that nicotine dependence may maintain a stronger relation with asthma than smoking and that there may be distinct developmental trajectories for asthma-smoking relations.

Background: Previous research examining anger problems among the anxiety disorders has been limited by the use of nonrepresentative samples, univariate analyses, as well as low sample size. The current study examined the association between posttraumatic stress disorder (PTSD), panic disorder (PD), social anxiety disorder, specific phobia (SP), and generalized anxiety disorder (GAD) and anger experience and expression. We hypothesized that greater anger experience and expression would be associated with all anxiety disorders, but that it would be most consistently associated with PTSD and PD diagnoses, and that these relationships would remain significant after controlling for demographics (i.e. age, gender, ethnicity, marital status, and income) and comorbid disorders., Methods: Participants included 5,692 (54% female) adults from the National Comorbidity Survey-Replication, a large, nationally representative survey., Results: Our data suggest that there are unique relationships between multiple anxiety disorders and various indices of anger experience and expression that are not better accounted for by psychiatric comorbidity. Contrary to predictions, PTSD and PD were not consistently associated with anger experience and expression., Conclusions: Overall, these findings lend support to the emerging literature demonstrating a potentially important relationship between anxiety disorders and anger problems., (© 2010 Wiley-Liss, Inc.)

Research has accumulated over the past several years demonstrating a relationship between childhood abuse and anxiety disorders. Extant studies have generally suffered from a number of methodological limitations, including low sample sizes and without controlling for psychiatric comorbidity and parental anxiety. In addition, research has neglected to examine whether the relationships between anxiety disorders and childhood abuse are unique to physical abuse as opposed to sexual abuse and vice versa. The current study sought to examine the unique relationships between anxiety disorders and childhood physical and sexual abuse using data from the National Comorbidity Survey-Replication. Participants (n=4141) completed structured interviews from which data on childhood abuse history, lifetime psychiatric history, parental anxiety, and demographics were obtained. After controlling for depression, other anxiety disorders, and demographic variables, unique relationships were found between childhood sexual abuse and social anxiety disorder (SAD), panic disorder (PD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD); in contrast, physical abuse was only associated with PTSD and specific phobia (SP). Further, among women, analyses revealed that physical abuse was uniquely associated with PTSD and SP, while sexual abuse was associated with SAD, PD, and PTSD. Among men, both sexual and physical abuse were uniquely associated with SAD and PTSD. Findings provide further evidence of the severe consequences of childhood abuse and help inform etiological accounts of anxiety disorders., (Copyright 2010 Elsevier Ltd. All rights reserved.)

This study examined the relations between marijuana use and panic attacks and panic disorder using a large representative survey of adults (N = 5,672; 53% women; M(age) = 45.05 years, SD = 17.9) conducted in the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (age, marital status, income, education, race, and sex) and the presence of a lifetime substance use disorder, lifetime marijuana use was significantly associated with increased odds of a lifetime panic attack history. Lifetime marijuana use also was significantly associated with an increased risk of current (past-year) panic attacks; however, this relation was not significant when controlling for nicotine dependence. Lifetime marijuana use was significantly associated with increased odds of a lifetime diagnosis of panic disorder as well as a current (past-year) diagnosis of panic disorder. Current (past-year) marijuana use was significantly associated with both lifetime and current panic attacks, but not current or lifetime panic disorder. Results are discussed in relation to the novel information they offer in regard to understanding the putative marijuana use-panic psychopathology association(s)., (2010 APA, all rights reserved)

Introduction: Research has generally found strong associations between smoking and anxiety disorders. The present study sought to examine the role of comorbidity in explaining these relationships., Methods: Participants from the National Comorbidity Survey-Replication (N = 5,692) were included in the present study. Axis I disorders were assessed using the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview. In addition, smoking and mental health treatment history were assessed., Results: Multivariate analyses covarying for demographic variables and psychiatric and substance use comorbidity found that posttraumatic stress disorder was uniquely associated with every smoking outcome of interest, including 12-month and lifetime daily and heavy smoking, nicotine dependence, and cessation failure. Generalized anxiety disorder and social anxiety disorder were associated with fewer smoking-related outcomes, and contrary to predictions, panic disorder was only independently associated with 12-month daily smoking. Panic attack history, however, was uniquely associated with 12-month daily and heavy smoking, nicotine dependence, and lifetime cessation failure. In addition, analyses indicated that greater number of anxiety disorders was associated with greater prevalence of each smoking outcome, and the presence of even one anxiety disorder was associated with elevated smoking prevalence., Discussion: Several specific anxiety disorders were found to be uniquely associated with smoking behavior. Findings suggest that comorbidity may only explain the associations with smoking difficulties for some anxiety disorders.

Little is known about the prevalence of panic attacks in PTSD and their influence on symptom severity and disability. Utilizing the National Comorbidity Survey-Replication data, respondents meeting DSM-IV criteria for past year PTSD (n=203) with and without comorbid panic attacks were compared across various dimensions. Past year panic attacks were found among 35% of the sample and were associated with greater PTSD-related disability and less time spent at work. Panic attacks were also associated with greater prevalence of comorbid depression, substance abuse/dependence, medically unexplained chronic pain, number of anxiety disorders and lifetime traumatic events, PTSD reexperiencing and avoidance/numbing symptoms, and treatment-seeking related to traumatic stress reactions. Multivariate analyses revealed that panic attacks were one of the only unique predictors of severe PTSD-related disability. Overall, findings suggest that panic attacks are common among individuals with PTSD; therapeutic strategies targeting panic in this population may be of significant benefit., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Research has generally found a "dose relationship" between potentially traumatic events (PTEs) and the likelihood of developing PTSD, with greater number of events associated with greater likelihood. Most of these studies have been cross-sectional, however. A recent prospective study (Breslau, Peterson, & Schultz, 2008) found that PTSD response to prior potentially traumatic event (PTE) exposure, rather than prior exposure itself, acts as a risk factor for PTSD in response to subsequent PTE; however, this analysis combined many different types of events, and the unique contribution of specific events (e.g., assault) that may be associated with differential risk of PTSD was indeterminable. The present study examined the effects of cumulative PTE exposure prospectively using a two-wave design in the National Survey of Adolescents (N = 1703). History of assault and witnessing serious violence were the focal PTEs examined. Wave I assault without PTSD was found to predict PTSD at Wave II following exposure to new assault or witnessed violence; however, among those without prior PTSD, Wave I witnessed violence did not increase risk of subsequent PTSD following exposure.

Objectives. Indices of low socioeconomic status (SES) have been found to predict negative health outcomes. However, problems meeting basic needs (e.g., not having enough money for health care, adequate food, etc.) may be a more potent measure of negative health outcomes than other more typically assessed indices of SES, such as income. This article examined the association between problems meeting basic needs and cognitive decline in a sample of community-dwelling Hispanic older adults (N = 1,964). Method. The authors used a prospective design to study the influence of problems meeting basic needs on cognitive functioning. Analyses controlled for demographics, health problems, and depressive symptoms. Results. The authors found problems meeting basic needs to be a more potent predictor of cognitive decline than income. Discussion. Interventions focused on providing older adults with resources for meeting basic needs, such as adequate food and health care, may substantially reduce the subsequent level of stress and health problems in this population.

Objective: The current study sought to examine the unique associations between anxiety disorders and suicidality using a large nationally representative sample and controlling for a number of established risk factors for suicide., Method: Data from the National Comorbidity Survey-Replication were used for analyses. Lifetime diagnostic history and demographics were obtained in this survey through a structured interview. Lifetime suicidal ideation and attempts were also assessed., Results: Multivariate analyses covarying for psychiatric comorbidity and demographic variables found social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD) to be unique predictors of suicidal ideation, while only SAD, PTSD, and GAD were predictive of suicide attempts. Analyses by gender indicated that each of these four disorders were predictive of suicidal ideation or suicide attempts among women, while only PTSD and PD acted as risk factors among men., Conclusions: Findings provide further evidence of the negative impact of anxiety disorders, suggest efforts should be made towards their early detection and treatment, and emphasize the importance of suicide risk assessment in treating individuals with anxiety disorders.

Previous research has suggested that both exposure to potentially traumatic events (PTEs) and emotional reactions to such events act as risk factors for subsequent exposure. Although some studies have implicated posttraumatic stress disorder (PTSD) symptoms as risk factors, extant research suffers from a number of methodological limitations, including the use of cross-sectional designs and student populations. The present study sought to address these limitations using a 2-year, 3-wave national probability household sample of 2,863 adult women. After controlling for demographic characteristics, prior exposure to PTEs, and Wave 1 depression and substance abuse, PTSD reexperiencing symptoms at Wave 1 predicted subsequent exposure to interpersonal violence victimization (IPVV) perpetrated by a nonintimate perpetrator; however, PTSD symptoms did not predict intimate partner IPVV. In addition, PTSD hyperarousal symptoms were unique predictors of subsequent exposure to other traumatic stressors. Findings suggest that efforts to prevent PTEs should focus attention on both prior exposure and PTSD symptoms in response to such exposure.

Background: A growing body of literature implicates major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) as risk factors for suicidal ideation (SI) and suicide attempts (SA), though research has not adequately examined their differential contributions to increasing suicide risk prospectively or cross-sectionally., Methods: The contribution of these disorders and their comorbidity to SI and SA was examined using a national household probability sample of women (N=3,085) and covarying for trauma history, substance abuse, and demographic variables., Results: Cross-sectional analyses indicated that lifetime comorbidity of MDD and PTSD were associated with much higher prevalence of SI than either diagnosis alone; prevalence of SI was elevated and comparable for PTSD and MDD only. Comorbid diagnosis and PTSD only groups displayed greater prevalence of SA than those with MDD only. Lastly, a 2-year prospective analysis indicated that PTSD only at baseline was predictive of greater subsequent SI risk than MDD only, though comorbid diagnosis did not differ from either PTSD only or MDD only., Conclusions: PTSD appears to be a particularly strong predictor of SI and SA. Overall, only 16% of women with lifetime SA did not have a history of MDD or PTSD, highlighting the importance of assessing these variables when assessing suicide risk.

Rachman [(1994). Pollution of the mind. Behaviour Research and Therapy, 32, 311-314] theorized that a subtype of compulsive washing exists which has its compulsions triggered by feelings of internal dirtiness, or 'mental pollution'. Since this construct was proposed, few empirical studies have examined it in relation to obsessive-compulsive contamination fear. This study represents a validation of the Mental Pollution Questionnaire (MPQ), which was developed for the measurement of mental pollution. Psychometric data were obtained from two studies using non-clinical samples. The final version of the MPQ consisted of eight items and two subscales related to washing and ideation. Higher mental pollution scores were associated with greater obsessions, contamination, and washing symptoms. In addition, MPQ scores were positively associated with inflated responsibility beliefs and thought-action fusion. Lastly, a third study found that both MPQ subscales predicted OC symptoms after controlling for general distress, trait guilt, and disgust sensitivity. Potential uses of the MPQ as a clinical and research instrument are discussed.

Although it has long been thought that experiencing an obsession is a psychiatric symptom, more recent literature, has seen the normalisation of obsessions and other presumably clinical phenomena. That is, not only people suffering from psychiatric disorders experience obsessions but non-clinical individuals also do so. Furthermore, it has been argued that such normal obsessions are very similar to abnormal ones, in terms of content. However, in the present study, evidence was obtained indicating that normal and abnormal obsessions do differ in content. A sample of 133 healthy undergraduates was given a list of 70 obsessions, with some originating from obsessive-compulsive disorder (OCD) patients, and others stemming from healthy volunteers. Participants were asked to indicate whether they had ever experienced these obsessions. Participants endorsed significantly more normal than abnormal obsessions, suggesting that the two kinds of obsessions do differ from each other. In addition, the experience of clinical obsessions was more strongly associated with scores on a measure of OCD symptoms, than was the experience of normal obsessions.

The present study sought to examine patterns of habituation in exposure and response prevention (ERP) treatment of compulsive hand washing. Sub-clinical compulsive washers (n=27) with illness or non-illness primary threats were compared in order to detect potential differences in response to a single session of ERP. Changes in anxiety, disgust, and urge to wash were analyzed, and significant reductions in both anxiety and disgust were noted. Urge to wash significantly declined among washers primarily concerned with illness; among those concerned with non-illness threats, urge to wash did not significantly decline. Moreover, anxiety was found to decline when controlling for disgust and vice versa. Lastly, when both anxiety and disgust were entered into a model predicting changes in urge to wash, anxiety but not disgust predicted urge to wash for those with illness-related threats; for washers with non-illness threats, the findings were the reverse. Several clinical and theoretical implications are discussed.

Cognitive models of obsessive-compulsive disorder [e.g., Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37(Suppl. 1), S29-S52] propose a key role for inflated responsibility for harm. Studies evaluating such beliefs typically use heterogeneous samples including several OCD subtypes. A recent investigation by Foa et al. [Foa, E. B., Sacks, M. B., Tolin, D. F., Prezworski, A., & Amir, N. (2002). Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension. Journal of Anxiety Disorders, 16(4), 443-453] found responsibility to be elevated in OC checkers, but not in non-checking OCD patients, relative to non-anxious controls. In that study, the responsibility measure included checking scenarios, thus leaving the possibility that these findings may have been due to criterion contamination. The present study investigated responsibility beliefs in OC checkers (n=39) and non-checkers (n=20), anxious controls (n=22), and non-clinical controls (n=69), using measures of responsibility which do not have item overlap with OCD symptoms. Results indicated that both OC groups showed greater responsibility beliefs relative to anxious and non-anxious controls. OC checkers endorsed greater responsibility appraisals than anxious and non-clinical control groups. In contrast, non-checking OCs reported greater responsibility appraisals than non-clinical controls, but did not differ from anxious controls and OC checkers. Results are discussed in the context of the cognitive model of OCD.

Inconsistencies in research on deficits in memory for actions in studies of obsessive-compulsive (OC) checking have refocused investigators on beliefs such as confidence in the accuracy of recall as a possible motivation for checking. Poor confidence in relation to recall may be specific (perceived poor recall for a particular event) or general (perceived poor memory ability for that class of events). The present study examines both perception of memory ability and confidence in recollections in OC checkers across a range of situations, obsessive and non-obsessive. These ratings were compared with those of non-checking obsessional patients, anxious controls and non-clinical controls. OC checkers reported poorer perception of memory ability than other groups in situations for which they are responsible, both OC relevant and OC non-relevant. OC checkers also reported lower confidence in recollections compared to the other groups; this was specific to obsessional situations for which they are responsible. These findings are considered in the context of the cognitive model of OCD.

Objective: The primary objectives of this study were to explore maternal history of perinatal loss and pregnancy wantedness as correlates of substance use during pregnancy., Method: The research design involved interviewing women who gave birth in Washington DC hospitals during 1992. Interview data included pregnancy history (prior births, induced abortions, miscarriages, and stillbirths), desire for the pregnancy (wanted, not wanted, mistimed), socio-demographic information, timing of onset of prenatal care, and substance use (cigarettes, alcohol, and drugs) during pregnancy., Results: A history of induced abortion was associated with elevated risk for maternal substance use of various forms; whereas other forms of perinatal loss (miscarriage and stillbirth) were not related to substance use. Unwanted pregnancy was associated with cigarette smoking during pregnancy, but not with any other forms of substance use., Conclusions: Reproductive history information may offer insight to professionals pertaining to the likelihood of women using substances in a later pregnancy.

The psychological consequences of induced abortion are complex and subject to both considerable controversy and methodological criticisms. While many women report feelings of relief immediately after the procedure, others report feelings of anxiety, which they attribute to their abortions. The purpose of the present study was to examine risk of generalized anxiety following unintended pregnancies ending in abortion or childbirth using a large representative sample of American women. Among all women, those who aborted were found to have significantly higher rates of subsequent generalized anxiety when controlling for race and age at interview. Implications of the findings are discussed. In particular, findings highlight the clinical relevance of exploring reproductive history in therapeutic efforts to assist women seeking relief from anxiety.

Thought-action fusion (TAF) is a cognitive bias that has been linked to obsessive-compulsive disorder (OCD). Preliminary evidence suggests schizotypal traits may be associated with some types of OCD obsessions but not others. We examined the relationship between each of the two major types of TAF (i.e., likelihood and moral), schizotypal traits, and OCD symptoms in 969 nonclinical undergraduate students. We hypothesized that likelihood TAF would be associated with schizotypal traits; whereas moral TAF would not. Consistent with prediction, schizotypal-magical thinking was significantly associated with likelihood TAF even after controlling for the effects of OCD symptoms, general anxiety, and depression. Moreover, the relationship between likelihood TAF and OCD symptoms was significantly attenuated after controlling for schizotypal traits. In contrast, moral TAF demonstrated negligible association with OCD symptoms, depression, or schizotypal traits. These findings provide preliminary support for the linkage between likelihood TAF and schizotypal traits.

Abortion is known to be associated with higher rates of substance abuse, but no studies have compared substance use rates associated with abortion compared to delivery of an unintended pregnancy. This study examines data for women in the National Longitudinal Survey of Youth whose first pregnancy was unintended. Women with no pregnancies were also used as a control group. Use of alcohol, marijuana, cocaine, and behaviors suggestive of alcohol abuse were examined an average of four years after the target pregnancy among women with prior histories of delivering an unintended pregnancy (n = 535), abortion (n = 213), or those who reported no pregnancies (n = 1144). Controls were instituted for age, race, marital status, income, education, and prepregnancy self-esteem and locus of control. Compared to women who carried an unintended first pregnancy to term, those who aborted were significantly more likely to report use of marijuana (odds ratio: 2.0), with the difference in these two groups approaching significance relative to the use of cocaine (odds ratio: 2.49). Women with a history of abortion also reported more frequent drinking than those with a history of unintended birth. With the exception of less frequent drinking, the unintended birth group was not significantly different from the no pregnancy group. Resolution of an unintended pregnancy by abortion was associated with significantly higher rates of subsequent substance use compared to delivering an unintended pregnancy. A history of abortion may be a useful marker for identifying women in need of counseling for substance use.

The aims of this study were to investigate exposure-based treatments for cynophobia (dog phobia) and to test a newly developed hybrid imaginal exposure treatment that we have named active imaginal exposure. The treatment introduces an in vivo coping component to imaginal exposure whereby the patient physically performs coping responses to an imagined feared stimulus. Eighty-two participants meeting DSM-IV criteria for specific phobia (animal subtype) were randomly assigned to one of three 30-min. treatments: (a) active-imaginal exposure (AI), (b) imaginal exposure alone (IE), or (c) graduated in vivo exposure (IV). Participants completed a behavioral approach test at pre, post, and four-week follow-up. Significant pre- to posttreatment improvement was observed in all three treatment conditions. Response rates at posttreatment were 51.9, 62.1, and 73.1% for the IE, AI, and IV groups respectively. Likewise, effect sizes at posttreatment were 0.76, 1.41, and 1.55 for the IE, AI, and IV groups respectively. Although in the predicted direction, the between group differences were not significant. A similar pattern of results was observed at follow-up. Further, safety behavior utilization during treatment was associated with less improvement--particularly in the two imaginal treatment conditions. Exposure treatments of dog phobia appear feasible and effective in reducing phobic fear and avoidance associated with dog phobia. Furthermore, preliminary evidence suggests that our active-imaginal exposure treatment may be a viable alternative to in vivo exposure.

Background: Existing research pertaining to emotional reactions to abortion is limited by (a) short follow up periods, (b) the absence of information on prior psychological state, and (c) lack of nationally representative samples. Therefore the purpose of this study was to compare women with a history of abortion vs. delivery relative to depression using a nationally representative longitudinal design, which enabled inclusion of a control for prior psychological state., Material/methods: The current study employed data for all women from the National Longitudinal Survey of Youth (NLSY) who experienced their first pregnancy event (abortion or childbirth) between 1980 and 1992 (n=1,884). Depression scores in 1992, an average of 8 years after the subjects' first pregnancy events, were compared after controlling for age, race, marital status, divorce history, education, income, and external locus of control scores. The latter was used to control for pre-pregnancy psychological state. Results were also examined separately for groups based on race, marital status, and divorce history., Results: After controlling for several socio-demographic factors, women whose first pregnancies ended in abortion were 65% more likely to score in the 'high-risk' range for clinical depression than women whose first pregnancies resulted in a birth. Differences were greatest among the demographic groups most likely to report an abortion., Conclusions: Abortion may be a risk factor for subsequent depression in the period of 8 years after the pregnancy event. The higher rates of depression identified may be due to delayed reactions, persistence of depression, or some other common risk factor.