Research & Scholarship

My research program utilizes a translational model to better understand the onset, maintenance, and treatment of anxiety disorders and their comorbidity with substance use disorders. In pursuit of this important knowledge, I use two interrelated and convergent approaches: (1) basic laboratory research examining clinically malleable factors that increase risk for anxiety psychopathology, and (2) clinical extensions of that basic research in the form of the development and evaluation of theoretically-driven psychosocial prevention and intervention strategies targeting difficult-to-treat anxiety populations. An overarching goal of my work is to identify malleable (changeable) cognitive, behavioral, and affective factors that can be clinically targeted using prevention or treatment strategies to alleviate anxiety psychopathology and comorbid conditions. My work is conducted from a biopsychosocial framework and uses a diverse range of methodologies, spanning from the laboratory to the field (cross-sectional and prospective), utilizes a variety of data analytic approaches, and has been extended and replicated across a variety of cultural or national groups to increase the generalizability of conclusions drawn from such work.

Currently, I am pursuing three interconnected lines of work. The first pertains to understanding the role of addictive-oriented health behaviors as risk factors for the development and maintenance of panic disorder and related conditions. Here, I have predominately studied the relationship between cigarette smoking and panic psychopathology, including mediating and moderating processes underlying their association. My basic research in this domain has indicated, across laboratory and prospective tests from various regions of the world (e.g., United States, Russia, and Mexico), that daily cigarette smoking is a clinically significant risk factor for developing panic psychopathology and impaired life functioning, particularly among smokers with pre-morbid or ongoing panic problems. It also has indicated that individual differences in sensitivity to anxiety and negative affect moderate such smoking-panic linkages. My current research program is focused on building upon this basic research knowledge and evaluating, in the context of a multi-site randomized clinical trial funded by NIMH, the utility of a novel 4-session intervention for removing (abstinence) or reducing (harm reduction) smoking behavior as a prevention tactic for decreasing the risk of developing panic attacks and panic disorder in the future.

A second line of work focuses on the role of emotional sensitivity and affect regulation factors in smoking maintenance and cessation outcome among smokers with anxiety disorders. This work has thus far indicated that anxiety sensitivity (fear of anxiety and bodily sensations) is related to affect-relevant (e.g., avoidance-oriented) smoking motivation and outcome expectancies, increased perceived barriers in quitting, low confidence in quitting, and exacerbated (perceived) intensity of nicotine withdrawal symptoms during periods of abstinence. I have used such knowledge in a theoretically-driven, translational manner to develop a specialized smoking cessation treatment program for daily smokers with anxiety disorders that uses fear reduction strategies (e.g., interoceptive exposure, emotional acceptance) during both withdrawal and non-withdrawal states prior to a quit attempt to facilitate abstinence, while simultaneously improving psychological health and addressing anxiety-related issues. This behavioral treatment program is currently being evaluated in the context of a NIDA-funded randomized clinical trial. An emerging line of inquiry emanating from this same domain involves extending our past work relevant to smoking and panic psychopathology to individuals with marijuana use disorders.

The final stream of work addresses emotional reactivity and affect tolerance variables and their role as potential ‘common risk factors’ in anxiety psychopathology and their comorbid conditions (e.g., substance use disorders). This line of currently-funded NIMH and NIDA-funded work has examined such variables as affect intensity, panic attacks, anxiety sensitivity, distress tolerance, and avoidance-oriented coping in terms of concurrent and prospective relations with anxiety psychopathology and life functioning (degree of impairment). Other work has helped to clarify the latent structure of these variables by using a variety of quantitative methods in integrative and novel ways (e.g., complementary usage of taxometric and confirmatory factor analytic methods). Studies in this domain, again ranging from laboratory to cross-national projects, have indicated that individual differences in the fear of the possible negative consequences of internal stimuli (anxiety sensitivity) are uniquely related to limited tolerance for negative affect and avoidance-oriented affect regulation; effects apparent above and beyond variance attributed to temperamental factors such as the generalized tendency to experience negative affect states (neuroticism). Such effects tend to be exacerbated when individuals are exposed to uncontrollable or unpredictable sources of personal threat (e.g., unexpected aversive bodily sensations, traumatic life events). I am currently using this empirical information to distill the mechanisms underlying associations between anxiety sensitivity and dysfunctional emotion regulation processes through studies conducted in the laboratory and among difficult-to-treat populations (e.g., incarcerated adults with anxiety and polysubstance use disorders). To advance the translational promise of this program of work, my colleagues and I recently developed a novel stage-model to guide field-wide programmatic research to more optimally translate basic psychopathology research into prevention programs targeting psychopathology. Thus, in addition to helping to advance psychological scientific theory related to vulnerability for anxiety psychopathology, this line of my research will help develop preventive interventions targeting cognitive-emotional variables to prospectively promote psychological health and well-being among vulnerable populations.

Overall, the described three lines of work have allowed for a better understanding of factors related to the onset, maintenance, and treatment of anxiety disorders and their comorbidity with substance use disorders. Importantly, this work has helped to identify previously unknown malleable risk factors for anxiety-related psychopathology. Moreover, it has shaped the development of previously unavailable intervention and prevention programs for difficult-to-treat populations such as persons with comorbid anxiety and substance use problems. Over the next decade, my focus will be to continue to develop and expand these interrelated lines of research, and evaluate the efficacy of the specialized intervention approaches we have developed as part of this work across culturally and developmentally diverse populations.