The unique and interactive effects of anxiety sensitivity and emotion dysregulation in relation to posttraumatic stress, depressive, and anxiety symptoms among trauma-exposed firefighters

Paulus, Daniel J.; Gallagher, Matthew W.; Bartlett, Brooke A.; Tran, Jana K.; Vujanovic, Anka A.

doi:10.1016/j.comppsych.2018.03.012

Cited by 52 publications

(38 citation statements)

References 61 publications

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“…Research in healthy adults has shown that higher levels of PA can reduce interleukin 6 and this may be the mechanism through which it exerts its protective effect (Jankord & Jemiolo, 2004). From a psychological perspective, self-reported PA can reduce anxiety sensitivity (Asmundson et al, 2013), which is the main focus in the genesis and maintenance of panic and other anxiety disorders (Paulus, Gallagher, Bartlett, Tran, & Vujanovic, 2018). Also, engaging in PA, particularly structured exercise, may directly improve psychological factors such as increasing self-efficacy regarding the ability to exert control over potential threats (Anderson & Shivakumar, 2013), thereby reducing the risk of developing anxiety.…”

Section: Discussionmentioning

confidence: 99%

Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies

et al. 2019

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Background Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta‐analysis has been conducted. Aims To examine the prospective relationship between PA and incident anxiety and explore potential moderators. Methods Searches were conducted on major databases from inception to October 10, 2018 for prospective studies (at least 1 year of follow‐up) that calculated the odds ratio (OR) of incident anxiety in people with high PA against people with low PA. Methodological quality was assessed using the Newcastle‐Ottawa Scale (NOS). A random‐effects meta‐analysis was conducted and heterogeneity was explored using subgroup and meta‐regression analysis. Results Across 14 cohorts of 13 unique prospective studies (N = 75,831, median males = 50.1%) followed for 357,424 person‐years, people with high self‐reported PA (versus low PA) were at reduced odds of developing anxiety (adjusted odds ratio [AOR] = 0.74; 95% confidence level [95% CI] = 0.62, 0.88; crude OR = 0.80; 95% CI = 0.69, 0.92). High self‐reported PA was protective against the emergence of agoraphobia (AOR = 0.42; 95% CI = 0.18, 0.98) and posttraumatic stress disorder (AOR = 0.57; 95% CI = 0.39, 0.85). The protective effects for anxiety were evident in Asia (AOR = 0.31; 95% CI = 0.10, 0.96) and Europe (AOR = 0.82; 95% CI = 0.69, 0.97); for children/adolescents (AOR = 0.52; 95% CI = 0.29, 0.90) and adults (AOR = 0.81; 95% CI = 0.69, 0.95). Results remained robust when adjusting for confounding factors. Overall study quality was moderate to high (mean NOS = 6.7 out of 9). Conclusion Evidence supports the notion that self‐reported PA can confer protection against the emergence of anxiety regardless of demographic factors. In particular, higher PA levels protects from agoraphobia and posttraumatic disorder.

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Section: Discussionmentioning

confidence: 99%

Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies

et al. 2019

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“…Relatedly, approximately 44.5% of PSP screened positive for one or more mental health disorders (Carleton, Afifi, Turner, Taillieu, Duranceau, et al, 2018) as well as high proportions reporting lifetime suicidal ideation (27.8%), planning (13.3%), and attempts (4.6%) (Carleton, Afifi, Turner, Taillieu, LeBouthillier, et al, 2018a). Indeed, there is growing evidence that PSP experience a diverse range of potentially problematic anxiety and depressive symptoms (Paulus, Gallagher, Bartlett, Tran, & Vujanovic, 2018). The reported mental health challenges among PSP may be related, at least in part, to frequent PTE exposures (Carleton, Afifi, et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Mental health training, attitudes toward support, and screening positive for mental disorders

Carleton

Afifi

Turner

et al. 2019

Cognitive Behaviour Therapy

102

123

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Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43-60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial.

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“…There is theoretical and empirical work supporting the notion that AS may, at least partially, explain the relationship between emotion dysregulation and PTSS. Limited research examining these factors in tandem provides evidence that emotion dysregulation and AS are associated with PTSS above and beyond shared variance (McDermott, Tull, Gratz, Daughters, & Lejuez, 2009; Naifeh, Tull, & Gratz, 2012; Paulus, Gallagher, Bartlett, Tran, & Vujanovic, 2018; Vujanovic, Zvolensky, & Bernstein, 2008). It has been posited that those with elevated emotion dysregulation may have greater difficulties distinguishing between internal sensations and negative emotions, so that they are more likely to view bodily sensations as uncontrollable and frightening (Tull, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…Although there is a theoretical overlap between AS, distress tolerance, and intolerance of uncertainty as higher‐order cognitive‐affective factors, evidence supports these constructs to be distinct (Bernstein, Zvolensky, Vujanovic, & Moos, 2009; Laposa, Collimore, Hawley, & Rector, 2015). Further, while emotion dysregulation relates to the aforementioned affective amplification variables, it has empirically been shown to be unique compared to AS (Paulus et al, 2018), distress tolerance (McHugh, Reynolds, Leyro, & Otto, 2013), and intolerance of uncertainty (Bottesi, Tesini, Cerea, & Ghisi, 2018). Research suggests that vulnerability to PTSS might be partially explained by both distress tolerance (Vujanovic, Litz, & Farris, 2015) and intolerance of uncertainty (Oglesby, Boffa, Short, Raines, & Schmidt, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, this study explored three separate mediators (AS, distress tolerance, and intolerance of uncertainty) of the relationship between emotion dysregulation and PTSS. However, in line with support for the specific contributions of emotion dysregulation and AS together in predicting PTSS (McDermott et al, 2009; Paulus et al, 2018), we hypothesized that distress tolerance and intolerance of uncertainty would not be significant mediators of the relationship between initial emotion dysregulation and Month‐1 PTSS. Finally, an exploratory aim included probing for emotion dysregulation subscales that may be driving any significant effects.…”

Section: Introductionmentioning

confidence: 99%

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Emotion dysregulation as a maintenance factor for posttraumatic stress symptoms: The role of anxiety sensitivity

et al. 2020

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Objectives The current study tested whether emotion dysregulation, assessed by the Difficulties in Emotion Regulation Scale (DERS), would predict posttraumatic stress symptoms (PTSS) through anxiety sensitivity (AS). Alternate cognitive‐affective mediators (i.e., distress tolerance and intolerance of uncertainty) were explored. Method A total of 259 trauma‐exposed community members (ages averaging 37.39; evenly distributed by gender) from a larger clinical trial targeting suicide risk factors completed a clinical interview and self‐report questionnaires at baseline, Week‐3, and 1‐month follow‐up appointments. Results AS at Week 3 significantly mediated the relationship between initial emotion dysregulation and 1‐month follow‐up posttraumatic stress symptoms (PTSS) after controlling for condition and baseline symptoms (β = .07; standard error = 0.03; 95% confidence interval = [0.01, 0.14]). Effects held for one out of six emotion dysregulation subscales. Distress tolerance and intolerance of uncertainty were not significant mediators (ps > .05). Conclusions This study demonstrates that emotion dysregulation may confer maintenance of PTSS through AS. Findings highlight potentially malleable targets for interventions.

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The unique and interactive effects of anxiety sensitivity and emotion dysregulation in relation to posttraumatic stress, depressive, and anxiety symptoms among trauma-exposed firefighters

Cited by 52 publications

References 61 publications

Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies

Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies

Mental health training, attitudes toward support, and screening positive for mental disorders

Emotion dysregulation as a maintenance factor for posttraumatic stress symptoms: The role of anxiety sensitivity

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