Background and Aims People with anxiety disorders are more likely to smoke and less likely to succeed when they try to quit. Anxiety sensitivity may underlie both phenomena, such that people with high anxiety sensitivity react to interoceptive distress by avoidance. This study aimed to test the efficacy of an exercise program that induced interoceptive distress and thereby created tolerance to this distress in a safe environment. Design, Setting and Participants Randomized clinical trial at four YMCA branches in Austin, Texas, USA. Participants [n = 150; 130 (86.7%) white; 101 (67.3%) female; meanage = 38.6, standard deviation (SD)age = 10.4] were adult, daily smokers with high anxiety sensitivity motivated to quit smoking, who reported no regular moderate‐intensity exercise. Interventions Participants were assigned a YMCA personal trainer who guided them through a 15‐week intervention aerobic exercise program. Participants assigned to the personalized intervention trained at 60–85% of their heart rate reserve (HRR), whereas participants assigned to the control intervention trained at 20–40% of their HRR. Participants in both groups received standard behavioral support and nicotine replacement therapy. Measurements The primary outcome was biologically verified 7‐day point prevalence abstinence (PPA) at 6‐month follow‐up. Findings Sixty‐one per cent of participants were available at the 6‐month follow‐up. PPA at 6 months was higher in the personalized intervention than the control intervention [27.6 versus 14.8%; odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.28, 3.80, P = 0.005], assuming missing at random. Anxiety sensitivity declined in both groups with no evidence that this differed between groups. Conclusions An exercise program of high intensity increased abstinence from smoking in people with high anxiety sensitivity, but may not have done so by reducing anxiety sensitivity.

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Objective Distress tolerance (DT; the perceived or actual ability to withstand negative internal states) has emerged as a promising transdiagnostic risk factor in clinically severe populations. However, little is known about etiological factors associated with the development of DT. We hypothesized that greater levels of childhood trauma would be associated with lower perceived and behavioral DT, beyond theoretically relevant covariates. Method The current investigation evaluated several childhood trauma types (i.e., physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) in relation to perceived (i.e., self-report) and behavioral DT in a sample of 87 trauma-exposed adults in acute-care psychiatric inpatient treatment. Results Results of hierarchical linear regression models indicated that greater childhood physical abuse and emotional neglect were significantly associated with higher perceived DT. Greater levels of emotional abuse were associated with lower perceived DT, and greater physical neglect was associated with lower behavioral DT. Conclusions DT may be differentially influenced by different forms of childhood trauma.

Preclinical and clinical data have shown that D-cycloserine (DCS), a partial agonist at the N-methyl-d-aspartate receptor complex, augments the retention of fear extinction in animals and the therapeutic learning from exposure therapy in humans. However, studies with non-clinical human samples in de novo fear conditioning paradigms have demonstrated minimal to no benefit of DCS. The aim of this study was to evaluate the effects of DCS on the retention of extinction learning following de novo fear conditioning in a clinical sample. Eighty-one patients with social anxiety disorder were recruited and underwent a previously validated de novo fear conditioning and extinction paradigm over the course of three days. Of those, only 43 (53%) provided analyzable data. During conditioning on Day 1, participants viewed images of differently colored lamps, two of which were followed by with electric shock (CS+) and a third which was not (CS-). On Day 2, participants were randomly assigned to receive either 50 mg DCS or placebo, administered in a double-blind manner 1 hour prior to extinction training with a single CS+ in a distinct context. Day 3 consisted of tests of extinction recall and renewal. The primary outcome was skin conductance response to conditioned stimuli, and shock expectancy ratings were examined as a secondary outcome. Results showed greater skin conductance and expectancy ratings in response to the CS+ compared to CS- at the end of conditioning. As expected, this difference was no longer present at the end of extinction training, but returned at early recall and renewal phases on Day 3, showing evidence of return of fear. In contrast to hypotheses, DCS had no moderating influence on skin conductance response or expectancy of shock during recall or renewal phases. We did not find evidence of an effect of DCS on the retention of extinction learning in humans in this fear conditioning and extinction paradigm.

IMPORTANCE Findings suggest that the efficacy of D-cycloserine (DCS) for enhancing exposure therapy may be strongest when administered after sessions marked by low fear at the conclusion of exposure practice. These findings have prompted investigation of DCS dosing tailored to results of exposure sessions. OBJECTIVE To compare tailored postsession DCS administration with presession DCS administration, postsession DCS administration, and placebo augmentation of exposure therapy for social anxiety disorder. DESIGN, SETTING, AND PARTICIPANTS This double-blind randomized clinical trial involved adults with social anxiety disorder enrolled at 3 US university centers. Symptom severity was assessed at baseline, weekly during treatment, and at 1-week and 3-month follow-up. Data analysis was

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