Anxiety Disorders: Tull MT

Morissette SB, Tull MT, Gulliver SB, Kamholz BW, Zimering RT. · Department of Psychiatry, Boston University School of Medicine, Boston, MA 02130, USA. · Psychol Bull. · Pubmed #17338599 No free full text.

Abstract: Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. The authors critically examined the relationships among anxiety, anxiety disorders, tobacco use, and nicotine dependence and reviewed the existing empirical literature. Future research is needed to better understand the interrelationships among these variables, including predictors, moderators, and mechanisms of action. Increased knowledge in these areas should inform prevention efforts as well as the development and improvement of smoking cessation programs for those with anxiety and other psychiatric disorders.

Tull MT, Stipelman BA, Salters-Pedneault K, Gratz KL. · Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA. · J Anxiety Disord. · Pubmed #18804947 No free full text.

Abstract: Both non-clinical panic attacks and panic disorder (PD) have been found to be associated with generalized anxiety disorder (GAD). This study examined a proxy risk factor model of the relationship between non-clinical panic attacks, PD, and GAD. Specifically, it was proposed that non-clinical panic attacks and PD predict GAD only due to their shared association with anxiety sensitivity (AS) and difficulties in emotion regulation. Results demonstrated that emotion regulation difficulties reliably predicted GAD above and beyond the experience of non-clinical panic attacks and PD. However, although PD lost strength as a predictor, it remained significantly associated with GAD in the full model, providing only partial support for the proposed proxy risk factor model. Findings speak to the underlying role of emotion regulation difficulties in GAD, and suggest that it may be the shared relationship of these difficulties with both PD and GAD that partially explain the association of these disorders.

Lejuez CW, Zvolensky MJ, Daughters SB, Bornovalova MA, Paulson A, Tull MT, Ettinger K, Otto MW. · Department of Psychology, University of Maryland, College Park, MD 20742, USA. · Behav Res Ther. · Pubmed #18466878 No free full text.

Abstract: The present study examined the extent to which anxiety sensitivity (AS) at treatment entry was related to prospective treatment dropout among 182 crack/cocaine and/or heroin-dependent patients in a substance use residential treatment facility in Northeast Washington, DC. Results indicated that AS incrementally and prospectively predicted treatment dropout after controlling for the variance accounted for by demographics and other drug use variables, legal obligation to treatment (i.e., court-ordered vs. self-referred), alcohol use frequency, and depressive symptoms. Findings are discussed in relation to the role of AS in treatment dropout and substance use problems more generally.

Tull MT, Roemer L. · University of Massachusetts, Boston, MA, USA. · Behav Ther. · Pubmed #18021952 No free full text.

Abstract: Emotion regulation difficulties among nonclinical uncued panickers were examined in two studies. In Study 1, participants with a recent history of uncued panic attacks (n=91), compared to a nonpanic sample (n=91), reported significantly greater levels of experiential avoidance, lack of emotional acceptance, and lack of emotional clarity. In Study 2, a subset of uncued panickers and nonpanickers from Study 1 (n=17 per group) viewed positive and negative emotion-eliciting film clips. Despite comparable levels of self-reported distress and physiological arousal, panickers reported using more emotionally avoidant regulation strategies during both film clips. Panic participants also responded with greater negative emotion to the positive emotion-eliciting clip. Results are discussed in terms of their research and clinical implications.

Tull MT, Jakupcak M, Paulson A, Gratz KL. · Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, USA. · Anxiety Stress Coping. · Pubmed #17999235 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) has been found to be associated with aggressive behavior. Recent evidence suggests that the ways in which individuals respond to their emotions may account for this relationship. In particular, to the extent that aggressive behaviors serve an emotion regulatory function, responding to emotions with avoidance (i.e., experiential avoidance) or the active suppression of emotional expression may heighten emotion dysregulation, increasing the risk for aggressive behavior as individuals attempt to regulate that dysregulated state. This study examined whether these two ways of responding to emotions account for the relationship between PTSD symptom severity and self-reported engagement in aggressive behavior among a diverse sample of 113 men with past exposure to interpersonal violence. Experiential avoidance and emotional inexpressivity each accounted for a significant amount of unique variance in aggressive behavior, above and beyond PTSD symptom severity and trait anger. Clinical and research implications of findings are discussed.

Tull MT, Rodman SA, Roemer L. · Center for Addictions, Personality, and Emotion Research and Department of Psychology, University of Maryland, College Park, MD 20742, USA. · J Anxiety Disord. · Pubmed #17851033 No free full text.

Abstract: Recent studies have demonstrated that individuals with a history of uncued panic attacks exhibit heightened difficulties in emotion regulation, including experiential avoidance, emotional non-acceptance, and lack of emotional clarity. The purpose of this study was to extend these findings by examining whether the fear of bodily sensations predicted the presence of experiential avoidance and emotional non-acceptance and whether body hypervigilance predicted a lack of emotional clarity in a sample of 91 individuals with a recent history (past year) of uncued panic attacks. Findings indicated that the fear of bodily sensations predicts experiential avoidance, emotional non-acceptance, and lack of emotional clarity above and beyond other panic-relevant variables. No evidence was found for a relationship between body hypervigilance and any emotion regulation difficulty. Findings are discussed in terms of their implications for improving the understanding of the development and treatment of emotion regulation difficulties among individuals with a history of panic attacks.

Tull MT, Barrett HM, McMillan ES, Roemer L. · Center for Addictions, Personality, and Emotion Research and Department of Psychology, University of Maryland, College Park, MD 20742, USA. · Behav Ther. · Pubmed #17697854 No free full text.

Abstract: This study examined the relationship between posttraumatic stress (PTS) symptoms and particular aspects of emotion regulation difficulties among trauma-exposed individuals. Participants were an ethnically diverse sample of 108 undergraduates from an urban university. PTS symptom severity was found to be associated with lack of emotional acceptance, difficulty engaging in goal-directed behavior when upset, impulse-control difficulties, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall difficulties in emotion regulation were associated with PTS symptom severity, controlling for negative affect. Finally, individuals exhibiting PTS symptoms indicative of a PTSD diagnosis reported greater difficulties with emotion regulation than those reporting PTS symptoms at a subthreshold level. The implications of these findings for research and treatment are discussed.

Gratz KL, Tull MT, Gunderson JG. · Center for Addictions, Personality, and Emotion Research and the Department of Psychology, University of Maryland, College Park, MD 20742, USA. · J Psychiatr Res. · Pubmed #17637464 No free full text.

Abstract: Although research on the temperamental vulnerabilities associated with borderline personality disorder (BPD) has focused primarily on the role of impulsive-aggression, affective instability, and emotional vulnerability, growing evidence suggests that anxiety sensitivity (AS) also may increase vulnerability for BPD. This study provides preliminary data on the relationship between AS and BPD, examining whether AS distinguishes outpatients with BPD from outpatients without a personality disorder (non-PD), and whether the relationship between AS and BPD is mediated by experiential avoidance (i.e., attempts to avoid unwanted internal experiences, such as anxiety). Findings indicate that BPD outpatients reported higher levels of AS than non-PD outpatients and AS reliably distinguished between these two groups. Furthermore, the relationship between AS and BPD was mediated by experiential avoidance. Finally, results indicate that AS (and experiential avoidance as a mediator) accounted for a significant amount of additional variance in BPD status above and beyond both negative affect and two well-established temperamental vulnerabilities for BPD (affect intensity/reactivity and impulsivity). Findings suggest the need to further explore the role of AS in the pathogenesis of BPD.

Tull MT, Jakupcak M, McFadden ME, Roemer L. · Department of Psychology, University of Maryland, College Park, Maryland 20742, USA. · J Nerv Ment Dis. · Pubmed #17632248 No free full text.

Abstract: Heightened negative affect (NA) intensity and the tendency to negatively evaluate emotions may be associated with the development and maintenance of posttraumatic stress symptoms. However, the specific role of these vulnerabilities has yet to be explored. Thus, this study was conducted to examine the influence of NA intensity and the fear of emotions in posttraumatic symptom severity among 102 childhood interpersonal violence victims. Fear of emotions significantly predicted posttraumatic symptom severity above and beyond NA intensity and NA. Findings suggest that posttraumatic outcomes may not be influenced by an underlying vulnerability of heightened NA intensity, but instead, are affected by the extent to which emotional responses are negatively evaluated. Results are discussed in terms of their implications for interventions and future research on posttraumatic responding.

Tull MT, Gratz KL. · Center for Addictions, Personality, and Emotion Research, University of Maryland, USA. · J Anxiety Disord. · Pubmed #17419002 No free full text.

Abstract: This study examined the role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed in the relationship between anxiety sensitivity (AS) and depressive symptom severity. A sample of 391 undergraduate students completed a series of questionnaires assessing the constructs of interest. Results provided support for a model where experiential avoidance and difficulties engaging in goal-directed behavior mediate the relationship between the AS dimensions of fear of cognitive dyscontrol and fear of publicly observable anxiety reactions and depressive symptom severity. The ability of this model to distinguish participants (N=53) reporting clinical levels of depression from those without (N=53) was then examined. The model was found to reliably distinguish between participants with and without clinical levels of depression. However, only experiential avoidance was a significant mediator. Implications for research on the role of AS in depression vulnerability and treatment are discussed.

Tull MT, Gratz KL, Lacroce DM. · Department of Psychology, University of Maryland, College Park, Maryland 20742, USA. · Cogn Behav Ther. · Pubmed #16754263 No free full text.

Abstract: Panic attacks and depression frequently co-occur, and the presence of this co-morbidity is often associated with worse outcomes compared with each disorder alone. Despite this, not everyone who experiences panic attacks also suffers from depression, suggesting that individual difference factors may play a role in this co-morbidity. The purpose of this study was to provide a preliminary investigation of two such individual difference factors, examining the role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non-clinical sample of uncued panickers. A sample of 79 college students reporting the occurrence of uncued panic attacks within the past year completed a series of questionnaires assessing the lower-order factors of anxiety sensitivity, emotional approach coping, panic attack frequency, panic-related disability, panic symptom severity and depressive symptom severity. Participants with more severe depressive symptoms reported greater anxiety sensitivity, panic attack frequency, panic symptom severity, panic-related disability and lack of emotional approach coping. The particular anxiety sensitivity dimension of fear of cognitive dyscontrol and lack of emotional approach coping emerged as the best predictors of depressive symptom severity. Findings are discussed in terms of their implications for the improved understanding of this co-morbidity, as well as its treatment.

Jakupcak M, Tull MT. · Mental Illness, Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA. · Violence Vict. · Pubmed #16248493 No free full text.

Abstract: This study assessed the impact of traumatic exposure and posttraumatic stress disorder (PTSD) symptoms on anger, aggression, and violence among civilian male college students. Results suggest that civilian men who have been exposed to a potentially traumatic event (PTE) and report symptoms of PTSD indicate more trait anger, more internal anger and hostility, and more aggression and violence than men who do not report symptoms of PTSD. Results are contrasted to those found in clinical samples of male veterans with PTSD and discussed in terms of understanding and treating anger and aggression in non-clinical, trauma-exposed populations.

Tull MT, Gratz KL, Salters K, Roemer L. · Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts 02125, USA. · J Nerv Ment Dis. · Pubmed #15505519 No free full text.

Abstract: This study examined the relationships between experiential avoidance in general (and thought suppression in particular), posttraumatic stress symptom severity, and symptoms of depression, anxiety, and somatization among a sample of individuals exposed to multiple potentially traumatic events. Although experiential avoidance was not associated with severity of posttraumatic stress symptoms beyond their shared relationship with general psychiatric symptom severity, it was associated with symptoms of depression, anxiety, and somatization when controlling for posttraumatic stress symptom severity. Thought suppression, on the other hand, was associated with severity of posttraumatic stress symptoms when controlling for their shared relationship with general psychiatric symptom severity. No significant relationships were found between thought suppression and the presence of depression, anxiety, and somatization symptoms when controlling for posttraumatic stress symptom severity. Results suggest the importance of separately examining the influence of different forms of experiential avoidance on posttraumatic psychopathology.