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Durham, NC, United States

Martindale S.L.,Baylor University | Martindale S.L.,Wg Bill Hefner Veterans Affairs Medical Center | Martindale S.L.,VA Mid Atlantic Mental Illness Research | Fils-Aime L.R.,University of North Texas | Dolan S.L.,Baylor University
Journal of Cognitive Psychotherapy | Year: 2016

Impulsivity and distress tolerance (DT) have been implicated as key features in development and maintenance of substance use disorders. This study expanded on previous research by exploring the four factors of DT (Absorption, Appraisal, Regulation, Tolerance) and their interaction with impulsivity in relation to substance use. Participants were 105 men and 150 women who completed measures of impulsivity, DT, and substance use. Results indicated that Appraisal DT was a better predictor of substance use problems over and above overall DT or other DT factors. Mediation analysis indicated that Appraisal partially mediated the relationship between impulsivity and DT. Results suggest that DT, particularly Appraisal, plays a role in substance use problems, specifically in the relationship between impulsivity and substance use problems. Treatments emphasizing DT skills, particularly the appraisal of aversive emotions, may be useful to employ when attempting to reduce harmful drinking or drug use behaviors. © 2016 Springer Publishing Company. Source


McClernon F.J.,Durham Veterans Affairs Medical Center | Calhoun P.S.,Durham Veterans Affairs Medical Center | Hertzberg J.S.,Durham Veterans Affairs Medical Center | Dedert E.A.,Durham Veterans Affairs Medical Center | And 2 more authors.
Psychology of Addictive Behaviors | Year: 2013

The risk of smoking increases with specific psychiatric diagnoses (e.g., posttraumatic stress disorder); but the risk has also been shown to increase as a function of the number of psychiatric illnesses with which a person is diagnosed. The current study examined this association and other correlates of smoking-psychiatric comorbidity in a sample of U.S. Iraq-and Afghanistan-era veterans who have served since September 11, 2001. The sample consisted of 1,691 veterans (Mage = 37.5 years, 20.2% women, 53.2% minority). Veterans completed measures of smoking history, nicotine dependence, and smoking expectancies; they also underwent a structured diagnostic interview to establish any current and/or lifetime psychiatric diagnoses. Consistent with previous studies, the number of comorbid diagnoses was significantly associated with both heavy (>20 cigarettes/day) and light-to-moderate (≤20 cigarette/day) smoking. Moreover, among current smokers, significant correlations between self-reported dependence and number of diagnoses were observed. Examination of self-reported smoking expectancies revealed that a greater number of diagnoses were associated with greater expectancies of negative affect reduction, stimulation and state enhancement, taste and sensorimotor manipulation, social facilitation, craving and addiction, and boredom reduction. The present findings confirm the association between the number of comorbid diagnoses reported in previous studies, and extends those findings by identifying smoking expectancies differences among smokers with comorbid diagnoses. © 2013 APA. Source


DeBeer B.B.,VISN | DeBeer B.B.,Texas A&M University | Kimbrel N.A.,Durham Veterans Affairs Medical Center | Kimbrel N.A.,VA Mid Atlantic Mental Illness Research | And 5 more authors.
Psychiatry Research | Year: 2014

Rates of suicide are alarmingly high in military and veteran samples. Suicide rates are particularly elevated among those with post-traumatic stress disorder (PTSD) and depression, which share overlapping symptoms and frequently co-occur. Identifying and confirming factors that reduce, suicide risk among veterans with PTSD and depression is imperative. The proposed study evaluated, whether post-deployment social support moderated the influence of PTSD-depression symptoms on, suicidal ideation among Veterans returning from Iraq and Afghanistan using state of the art clinical, diagnostic interviews and self-report measures. Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans (n=145) were invited to, participate in a study evaluating returning Veterans[U+05F3] experiences. As predicted, PTSD-depression, symptoms had almost no effect on suicidal ideation (SI) when post-deployment social support was high; however, when, post-deployment social support was low, PTSD-depression symptoms were positively associated with, SI. Thus, social support may be an important factor for clinicians to assess in the context of PTSD and, depressive symptoms. Future research is needed to prospectively examine the inter-relationship, between PTSD/depression and social support on suicidal risk, as well as whether interventions to, improve social support result in decreased suicidality. © 2014. Source


Kimbrel N.A.,Duke University | Calhoun P.S.,Duke University | Elbogen E.B.,University of North Carolina at Chapel Hill | Brancu M.,Duke University | And 2 more authors.
Psychiatry Research | Year: 2014

The present research examined how incarceration, suicide attempts, suicidality, and difficulty controlling violence relate to the underlying factor structure of psychiatric comorbidity among a large sample of Iraq/Afghanistan-era veterans (N=1897). Diagnostic interviews established psychiatric diagnoses; self-report measures assessed history of incarceration, difficulty controlling violence, suicide attempts, and suicidality. A 3-factor measurement model characterized by latent factors for externalizing-substance-use disorders (SUD), distress, and fear provided excellent fit to the data. Alcohol-use disorder, drug-use disorder, and nicotine dependence were indicators on the externalizing-SUD factor. Posttraumatic stress disorder and depression were indicators on the distress factor. Panic disorder, social phobia, specific phobia, and obsessive-compulsive disorder were indicators on the fear factor. Incarceration was exclusively predicted by the externalizing-SUD factor. Difficulty controlling violence, suicidality, and suicide attempts were exclusively predicted by the distress factor. Contrary to hypotheses, the path from the externalizing/SUD factor to difficulty controlling violence was not significant. Taken together, these findings suggest that the distress factor of psychiatric comorbidity is a significant risk factor for suicidality, suicide attempts, and difficulty controlling violence and could help to explain the frequent co-occurrence of these critical outcomes among returning Iraq/Afghanistan veterans. © 2014. Source


Kimbrel N.A.,Durham Veterans Affairs Medical Center | Kimbrel N.A.,VA Mid Atlantic Mental Illness Research | Evans L.D.,Central Texas Veterans Health Care System | Evans L.D.,Texas A&M University | And 9 more authors.
Psychiatry Research | Year: 2014

The objective of the present research was to develop and evaluate a critical warzone experiences (CWE) scale for use with Iraq/Afghanistan veterans. The psychometric properties of the CWE were evaluated across three independent samples of Iraq/Afghanistan veterans. Despite its brevity (7 items), the CWE exhibited good internal consistency (average α =0.83), good temporal stability (1-year test-retest reliability=0.73), good concurrent validity with lengthier measures of warzone experiences (average r=0.74), and a clear unidimensional factor structure (average factor loading=0.69). Study 2 confirmed the CWE[U+05F3]s factor structure through confirmatory factor analysis, and structural equation modeling demonstrated a strong association between CWE and post-deployment mental health, β =0.49, p<0.001. Study 3 provided further support for the predictive validity of the CWE by demonstrating that it was associated with PTSD diagnosis, clinician-rated PTSD symptom severity, and global functional impairment in an independent sample of Iraq/Afghanistan veterans (average r=0.59). While replication of these findings in more diverse samples is needed, the preliminary evidence from these studies indicates that the CWE is a brief, reliable, and valid measure of critical warzone experiences among Iraq/Afghanistan war veterans. © 2014. Source

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