Anxiety Sensitivity, Emotional Avoidance, and PTSD Symptom Severity Among Crack/Cocaine Dependent Patients in Residential Treatment

Abstract

High rates of co-occurring posttraumatic stress disorder (PTSD) have been found among patients receiving treatment for substance use disorders (SUD), and there is evidence that this particular co-occurrence is associated with negative SUD treatment outcomes. Thus, there is utility in establishing the role of psychological vulnerabilities related to PTSD within SUD populations, with the goal of ultimately informing targeted interventions and improving clinical outcomes. Anxiety sensitivity (AS) and emotional avoidance (EA) may be two important factors in this regard, as both have been found to demonstrate associations with posttraumatic stress in other clinical and nonclinical populations. To expand upon this literature, the current study examined the associations between AS and EA and PTSD symptom severity in a sample of traumatic event-exposed crack/cocaine dependent patients in residential SUD treatment (n = 62), as well as the extent to which EA mediated the relation between AS and PTSD symptom severity. As hypothesized, AS and EA were associated with PTSD symptom severity above and beyond the effects of gender and non-specific anxiety symptoms. However, the hypothesis that EA would mediate the relation between AS and PTSD symptom severity was only partially supported. Implications of these findings for understanding and treating co-occurring SUD-PTSD are discussed.

The Underlying Role of Negative Affect in the Association between PTSD, Major Depressive Disorder, and Generalized Anxiety Disorder

“…Further, presence of an additional diagnosis (e.g., substance use, mood disorder) was more strongly associated with comorbid PTSD and GAD (Milanak et al 2013). PTSD symptom severity has also been associated with more severe general anxiety Grant et al 2008;Naifeh et al 2012) in military veterans , motor vehicle accident victims (Grant et al 2008), and substance dependent inpatients (Naifeh et al 2012).…”

The Role of Guanfacine as a Therapeutic Agent to Address Stress-Related Pathophysiology in Cocaine-Dependent Individuals

“…Although there is a paucity of data regarding the prevalence of co-morbid anxiety disorders, possibly due to the fact that cocaine is less commonly thought to be consumed in individuals with a pre-disposition for anxiety, a NESARC survey documented that 31% of individuals with cocaine dependence reported lifetime anxiety disorders (Conway, Compton, Stinson, & Grant, 2006) and paranoia has also been documented as occurring in 68% to 84% of patients using cocaine (Morton, 1999). The clinical relevance of this is highlighted by the fact that severity of withdrawal-related anxiety has been found to impact the course, treatment outcome, and prognosis of both syndromes (Naifeh, Tull, & Gratz, 2012; O'Leary et al, 2000) (Sanchez-Hervas & Llorente del Pozo, 2012), particularly in women (Ambrose-Lanci, Sterling, & Van Bockstaele, 2010; Back et al, 2005; Chaplin, Hong, Bergquist, & Sinha, 2008; H. C. Fox & Sinha, 2009).…”

Interactive Effects of Anxiety Sensitivity and Difficulties in Emotion Regulation: An Examination Among Individuals in Residential Substance Use Treatment with Comorbid Posttraumatic Stress Disorder

“…Similarly, a more recent study found that emotional avoidance and AS were uniquely predictive of PTSD symptom severity in substance dependent patients even when accounting for anxiety severity and participant sex (Naifeh, Tull, & Gratz, 2012). When emotional avoidance and AS were considered simultaneously, AS no longer significantly predicted PTSD severity, suggesting that the relationship between AS and PTSD was indirect through emotional avoidance.…”