Anxiety sensitivity and hazardous drinking among persons living with HIV/AIDS: An examination of the role of emotion dysregulation

Abstract

Hazardous drinking is prevalent among persons living with HIV/AIDS (PLWHA). Anxiety sensitivity is a vulnerability factor that is highly associated with hazardous drinking among seronegatives, but has yet to be tested in PLWHA. Additionally, there is a need to examine potential mechanisms underlying associations of anxiety sensitivity and hazardous drinking. Emotion dysregulation is one potential construct that may explain the association between anxiety sensitivity and hazardous drinking. The current study examined emotion dysregulation as a potential explanatory variable between anxiety sensitivity and four, clinically significant alcohol-related outcomes among PLWHA: hazardous drinking, symptoms of alcohol dependence, number of days consuming alcohol within the past month, and degree of past heavy episodic drinking. The sample included 126 PLWHA (Mage=48.3; SD=7.5; 65.9% male). Results indicated significant indirect effects of anxiety sensitivity via emotion dysregulation in all models. Indirect effects (κ2) were of medium effect size. Alternative models were run reversing the predictor with mediator and, separately, reversing the mediator with the proposed outcome(s); alternative models yielded non-significant indirect effects in all but one case. Together, the current results indicate that anxiety sensitivity is associated emotion dysregulation, which, in turn, is associated with hazardous drinking outcomes. Overall, these findings may provide initial empirical evidence that emotion dysregulation may be a clinical intervention target for hazardous drinking.

Emotion dysregulation explains associations between anxiety sensitivity and hazardous drinking and drinking motives among adult treatment-seeking smokers.

“…Such findings are consistent with past work linking deficits in emotional clarity to increased affective (e.g., anxiety and depression) symptoms, greater alcohol use (Vine & Aldao, 2014), and alcohol-related consequences (Dvorak et al, 2014) and other work demonstrating the mediating role of emotional clarity in the associations between trauma symptoms and alcohol misuse (Tripp & McDevitt-Murphy, 2015). Additionally, there was a specific indirect effect of anxiety sensitivity via difficulties engaging in goal-directed behavior in relation to alcohol consumption, consistent with past work suggesting that difficulties with goals underlie associations between negative affectivity and alcohol use (Paulus, Bakhshaie, et al, 2016) and between posttraumatic stress symptoms and alcohol-related outcomes (Goldstein, Bradley, Ressler, & Powers, 2016; Tripp, McDevitt-Murphy, Avery, & Bracken, 2015). Regarding motives for use, there was a specific indirect effect of anxiety sensitivity via nonacceptance of emotional responses in relation to conformity motives for alcohol use.…”

“…The individual may then be more prone to engage in hazardous drinking, drinking to conform, and drinking to cope with distress in an effort to regulate negative affect. Partial support for this hypothesis comes from past work examining indirect associations of anxiety sensitivity via emotion dysregulation in relation to alcohol consumption and problems among psychiatric inpatients (Paulus, Vujanovic, & Wardle, 2016) and persons living with HIV (Paulus, Jardin, et al, 2016). Importantly, this past work has found non-significant indirect effects of anxiety sensitivity via emotion dysregulation, adding support for the theoretical model posited here.…”

The indirect effect of panic disorder on smoking cognitions via difficulties in emotion regulation

“…One investigation found that anxiety sensitivity, a well-known risk factor of PD, is associated with greater negative affect smoking motives, outcome expectances, and perceived cessation barriers, through its relation to difficulty in ER, among treatment-seeking daily smokers (Johnson, Farris, Schmidt, & Zvolensky, 2012). Other work has found similar effects for alcohol (Paulus et al, 2016). In addition, whereas previous research on smokers has found that ER may be modified via brief cognitive interventions (e.g., Szasz, Szentagotai, & Hofmann, 2012), its role has not been examined in a clinical population or examined as a treatment adjunct.…”

How does anxiety sensitivity increase risk of chronic medical conditions?

“…A number of studies on undergraduate, community, and clinical samples have shown that AS is associated with greater consumption of alcohol and/or more problems with alcohol use (e.g., Chavarria et al., ; Howell, Leyro, Hogan, Buckner, & Zvolensky, ; Woicik, Stewart, Pihl, & Conrod, ). Two cross‐sectional studies examining the link between AS and alcohol‐related outcomes among adult smokers and people living with HIV/AIDS, respectively, found that difficulties with emotion regulation mediated the relationship between AS and hazardous drinking (Paulus, Jardin, et al., ; Paulus et al., ), suggesting the potential additional role of maladaptive regulation of negative affect in the link between AS and alcohol use in these medical populations. There is also some evidence of a link between AS and increased cannabis use (Paulus, Manning, Hogan, & Zvolensky, ) and increased coping and conformity motives for use (Bonn‐Miller, Zvolensky, & Bernstein, ; Zvolensky, Marshall, et al., ), although a recent cross‐sectional study found that lower distress tolerance was associated with increased cannabis dependence symptoms and stronger coping motives, whereas AS was not (Farris, Metrik, Bonn‐Miller, Kahler, & Zvolensky, ).…”