Doctor of Philosophy (PhD), Ohio University, 2023, Clinical Psychology (Arts and Sciences)

Anxiety disorders represent the most prevalent form of psychopathology, affecting nearly 20% of the US youth population. Anxiety sensitivity (AS), or fear of anxious arousal due to misperceived threat, is a well-established risk factor for anxiety. Parent characteristics pertaining to COVID-19 worry, avoidance, and restriction of children's activities may increase youth anxiety. Further, parents with elevated AS model maladaptive behaviors, leading to higher youth anxiety. The current study examined the longitudinal effects of parent characteristics on child anxiety, during the COVID-19 pandemic. It was hypothesized first, that parent COVID-related worry, avoidance, restriction of children's activities, and AS would be significantly related to child anxiety longitudinally, and second, that the relation between parent COVID-related characteristics and child anxiety would be significantly greater for youth whose parents experience elevated AS. Participants comprised 498 parents who had school-aged children between the ages of four and eleven. Participants completed three waves of questionnaires, via Mechanical Turk, examining parent and child emotional and behavioral health, longitudinally. Structural equation modeling was used to examine the effects of baseline parent COVID-related characteristics (i.e., COVID worry, avoidance, restriction of youth activities) and parent AS, as well as interactions between COVID-related characteristics and parent AS, on month six youth anxiety. Correlation analyses indicated that child anxiety was significantly, positively associated with COVID worry and restriction, as well as parent AS. Main analyses revealed that baseline youth anxiety was significantly, positively associated with month six youth anxiety. There were no significant relations or interactions found among any parenting variables (COVID worry, avoidance, and restriction) or parent AS, predicting youth anxiety. Overall, this study contributes to our understanding of the (open full item for complete abstract)

Committee: Darcey Allan Ph.D. (Committee Chair); Nicholas Allan Ph.D. (Advisor); Allison Siroky Ph.D. (Committee Member); Berkeley Franz Ph.D. (Committee Member); Timothy Allan Ph.D. (Committee Member) Subjects: Clinical Psychology

Master of Arts, Miami University, 2023, Psychology

In recent years, rates of treatment access for child anxiety have not increased, despite an increasing frequency of diagnosis (Lebrun-Harris et al., 2022), calling into question barriers parents face in seeking treatment for their children's anxiety. One barrier is parental recognition of a problem, which could be affected by parental anxiety sensitivity (PAS; Francis, 2014; Reardon et al., 2017). The current study investigated the relation between PAS and help-seeking behaviors and intentions of parents on behalf of their children. Participants were 125 mothers who participated in a longitudinal study at child age 4 (Time 1) and a follow-up survey about 5 years later (Time 2). At Time 1, mothers completed self-report measures to assess PAS (Taylor et al., 2007) and child anxiety (Reynolds & Kamphaus, 2004). At Time 2, mothers completed measures of past help-seeking behaviors and help-seeking intentions (Rickwood et al., 2005; Wilson et al., 2005). Results indicated mothers with higher PAS reported their children to have more anxiety symptoms, and maternal perception of anxiety predicted actual help-seeking behavior. These results are consistent with the notion that PAS heightens awareness of child anxiety in a way that facilitates actual help-seeking behavior. However, PAS did not, itself, relate to help-seeking.

Committee: Elizabeth Kiel (Committee Chair); Jennifer Green (Committee Member); Aaron Luebbe (Committee Member) Subjects: Clinical Psychology; Psychology

Doctor of Philosophy (PhD), Ohio University, 2023, Clinical Psychology (Arts and Sciences)

Given a need for affordable and accessible brief treatments for anxiety, we and our colleagues have been iteratively developing Brief Enhanced Anxiety Sensitivity Treatment (Group BEAST), a one-session virtual group treatment targeting anxiety sensitivity (AS), a risk factor of anxiety. Older versions of Group BEAST include psychoeducation, interoceptive exposure (IE), and IE homework. Several studies showed that the previous versions of Group BEAST reduced AS and, through the reductions in AS, they also reduced anxiety. However, the effect sizes for the decrease in anxiety were modest. Efficacy and personalization may be improved using Ecological Momentary Intervention (EMI). EMI delivers brief interventions remotely in real-time and in natural settings. The goal of the current study was to test the efficacy of adding EMI to Group BEAST. Participants were randomly assigned to EMI and control (no EMI) conditions. All participants received a virtual 1.5-hour-long intervention group session facilitated by a therapist, did IE homework, and received daily reminders to do homework. The EMI group received individualized intervention messages on their phone helping them to use new skills for two weeks after the session. After the two-week EMI period, there was a similar significant reduction in AS in both the EMI and the control groups (dz EMI = -.73, dz control = -.48), which held by one-month follow-up (dz EMI = -.63, dz control = -.72). There was no effect of EMI on the decrease of AS. From baseline to one-month follow-up there were significant reductions in anxiety in both groups (dz EMI = -.63, dz control = -.76,). The EMI group showed less improvement in anxiety than the control group. In the mediation model, there was no mediation effect of condition on anxiety at follow-up through AS at post-treatment. EMI had no effect on AS or anxiety. However, AS at post-treatment was associated with anxiety at follow-up (r = .50, p < .001). The results suggest that Group BEAST (open full item for complete abstract)

Committee: Nicholas Allan (Committee Member); Julie Suhr (Committee Chair); Darcey Allan (Committee Member); Megan Austin (Committee Member); Janet Simon (Committee Member) Subjects: Clinical Psychology; Therapy

Master of Science (MS), Ohio University, 2023, Experimental Psychology (Arts and Sciences)

The COVID-19 pandemic had a significant impact on mental health, straining an already overburdened treatment system. A transdiagnostic approach to psychological treatment is ideal for treating psychological distress in a brief format, reducing clinician burden without compromising treatment outcomes. The Coping Crew pilot intervention was run to test the feasibility and acceptability of a group, remote Cognitive Behavioral Therapy (CBT) protocol targeting transdiagnostic risk factors identified as maintaining maladaptive psychopathology during the COVID-19 pandemic. Seventeen participants were run across four groups in a one-arm pilot trial. We predicted that AS, IU, loneliness, anxiety, depression, and COVID-19-related distress would be reduced for individuals who received the Coping Crew intervention. Discriminant validity was briefly explored using the AUDIT. We tested our hypotheses using a series of repeated measures ANOVAs and found significant reductions in AS (Cohen's d = 1.12; p= .001) and IU (Cohen's d = 2.25; p < .001) from baseline to post-intervention. Sizeable effect sizes were found in all outcome variables, excluding depression. Feasibility and acceptability were supported. Our results provide preliminary evidence for the efficacy of a brief, remote CBT intervention in reducing transdiagnostic risk factors. A fully powered RCT is needed to determine whether this protocol is efficacious in the reduction of loneliness, anxiety, depression, and COVID-19-related distress.

Committee: Nicholas Allan (Advisor); Darcey Allan (Advisor); Ronaldo Vigo (Committee Member) Subjects: Psychology

Doctor of Philosophy (PhD), Ohio University, 2022, Clinical Psychology (Arts and Sciences)

Social anxiety disorder (SAD) is associated with diffuse impairment and constitutes a substantial public health burden. To better understand how social anxiety develops, it is crucial to identify how risk factors contribute to social anxiety. Anxiety sensitivity social concerns (ASSC), defined as the fear of publicly observable anxiety symptoms, and fear of negative evaluation (FNE), defined as distress arising from concerns about negative judgment, are risk factors that may amplify anxiety following social stressors. However, it is unclear how ASSC and FNE influence acute anxiety following stressors in naturalistic settings. In the current study, the impact of ASSC and FNE on anxious arousal (panic symptoms) and anxious apprehension (worry symptoms) following stressors was examined in a sample of community adults (N = 83; M age = 29.66 years, SD = 12.49, 59.0% female) who completed questionnaires five times per day over a two-week period. Dynamic structural equation modeling was used to examine predictors of overall levels of anxiety as well as anxiety following social and nonsocial stressors. ASSC interacted with the presence of social stressors, such that ASSC positively predicted anxious arousal following social stressors. FNE interacted with the presence of nonsocial stressors to predict anxious arousal and anxious apprehension, such that FNE positively predicted anxiety following nonsocial stressors. These findings suggest ASSC may specifically amplify anxious arousal following social stressors, whereas FNE may broadly amplify anxiety following nonsocial stressors.

Committee: Nicholas Allan Ph.D. (Advisor) Subjects: Clinical Psychology

PhD, University of Cincinnati, 2019, Arts and Sciences: Psychology

Health anxiety is defined as fear of having or obtaining a serious illness or disease that is excessive relative to actual physical health status. It is estimated that individuals with severe health anxiety utilize 41%-78% more healthcare resources than individuals with a true medical condition. Thus, identifying targets for intervention and prevention efforts for severe health anxiety that are appropriate for primary care or specialty clinic settings is imperative. The aim of the present investigation was to evaluate the effects of a single-session, computerized anxiety sensitivity (AS) reduction intervention on self-report and behavioral indices of AS and health anxiety. Participants were 68 students recruited from the University of Cincinnati demonstrating elevated levels of AS and health anxiety. Participants were randomized to either the active condition (psychoeducation + interpretation bias modification; Capron et al., 2017) or the control condition (study skills training + sham interpretation bias modification) using a 1:1 allocation ratio. Self-report measures were completed at pre-intervention, post-intervention, one-week follow-up, and one-month follow-up. Participants completed a straw-breathing challenge at post-intervention and one-week follow-up, and a series of health-related behavioral avoidance tasks at one-week follow-up. Results indicated a significant Time x Condition interaction for ASI-3 at each follow-up assessment such that individuals in the active condition exhibited greater reductions in AS compared to the control condition. There was no significant Time x Condition interaction for health anxiety at any follow-up assessment, though the between-group effect size was medium at one-month follow-up. No significant effects were observed for behavioral task outcomes. The current findings suggest that this intervention improves AS and shows promise in terms of its ability to reduce health anxiety. A larger trial powered to detect differences in (open full item for complete abstract)

Committee: Kristen Jastrowski Mano Ph.D. (Committee Chair); Jennifer Brown Ph.D. (Committee Member); Jeffery Epstein Ph.D. (Committee Member); Alison McLeish Ph.D. (Committee Member) Subjects: Psychology

Master of Science (MS), Ohio University, 2019, Clinical Psychology (Arts and Sciences)

Social anxiety disorder (SAD) is characterized by maladaptive distress, anxiety, and avoidance in social situations. Perfectionistic self-presentation (PSP; the desire to present a perfect image to a social audience) and anxiety sensitivity (AS) social concerns (the fear of publicly observable anxiety symptoms) have been identified as potential risk factors of social anxiety. However, no studies have investigated the interplay between PSP, AS social concerns, and social anxiety. The current study examined potential ways that PSP and AS social concerns could confer risk for social anxiety by comparing a mediation and moderation model using structural equation modeling. Participants included 390 community adults recruited on Mturk that completed measures at baseline, month 3, and month 6 and responded correctly to validity items. Prior to comparing structural models, factorial invariance was established for all constructs. The planned mediation model evidenced suppression effects, and the moderation model failed to converge, suggesting poor model specification. Mediation and moderation models were then estimated using manifest variables, which provided a divergent pattern of results than the models using latent variables. The current findings are not consistent with either PSP or AS social concerns serving as mediators/moderators for the other construct. These findings highlight a need for future research to elucidate mechanisms of risk for social anxiety.

Committee: Nicholas Allan Ph.D. (Advisor); Tim Anderson Ph.D. (Committee Member); Ryan Shorey Ph.D. (Committee Member) Subjects: Clinical Psychology

MA, University of Cincinnati, 2016, Arts and Sciences: Psychology

Health anxiety is a preoccupation with one's health without objective reason for concern and involves health-related worry, body vigilance, and excessive reassurance-seeking from physicians in order to gain certainty regarding health status. Given the role that uncertainty plays in health anxiety, researchers have demonstrated associations between intolerance of uncertainty, broadly defined as negative reactions to uncertainty, and greater health anxiety in both clinical and non-clinical populations. However, despite this well-established relationship, further work is needed to identify mechanisms that underlie this association. Given that AS, particularly the physical concerns domain, also negatively impacts health anxiety, AS may serve as such an explanatory factor. Thus, the purpose of the present investigation was to examine the indirect effect of AS-Physical Concerns in terms of the associations between IU and health anxiety. Participants were 640 medically healthy undergraduate students (68.1% female, Mage = 19.21, SD = 2.10). A simple mediation analysis was conducted using PROCESS (Hayes, 2013) to examine the indirect effect of the predictor variables (global IU [X1], prospective IU [X2], and inhibitory IU [X3]) on the criterion variable (SHAI [Y]) through the proposed mediator (ASI-PC [M]) using bias-corrected bootstrapping in order to directly test the significance of the indirect effect (10,000 resamples; Hayes, 2013). Consistent with hypothesis, after controlling for gender and negative affect, there was a significant indirect effect of AS-Physical Concerns in terms of the relationship between Global IU (indirect effect = .05; SE = .01; 95% CI = .02 to .06), and both Prospective (indirect effect = .04; SE = .02; 95% CI = .02 to .08) and Inhibitory IU (indirect effect = .11; SE = .03; 95% CI = .06 to .17) and health anxiety. These findings suggest that individuals who experience negative reactions to uncertainty have higher levels of health anxiety because (open full item for complete abstract)

Committee: Alison Mcleish Ph.D. (Committee Chair); Farrah Jacquez Ph.D. (Committee Member); Kristen Jastrowski Mano Ph.D. (Committee Member) Subjects: Psychology

Master of Arts, University of Toledo, 2011, Psychology

This study examined gender differences in the relationship between vicarious learning experiences and anxiety sensitivity, general anxiety and panic. Additionally, the current research examined empathy as a mediator of the relationship between vicarious learning experiences and anxiety sensitivity, general anxiety, and panic. Four hundred and thirty-six adult college students completed a battery of self reports on childhood learning experiences, empathy and symptomatology of panic, anxiety and anxiety sensitivity. Multiple regression analyses to test this model were not significant. Interestingly, however, logistic regression demonstrated that females who reported a history of vicarious learning history had a 34% probability of experiencing panic attack in the past year while males had a probability of 18%. Gender differences in overall anxiety, empathy, and frequency of panic attacks replicated important findings in previous literature. Overall, the current results provide information important for identifying those at risk for experiencing panic attacks in adulthood.

Committee: Laura Seligman PhD (Committee Chair); Jeanne Brockmyer PhD (Committee Member); John Jasper PhD (Committee Member); Jon Elhai PhD (Committee Member) Subjects: Psychology

Doctor of Philosophy, Miami University, 2025, Psychology

There are many consequences associated with college alcohol use, including missing classes, assault, injury, and death. Thus, studying factors related to alcohol use in undergraduates is needed. One such factor is anxiety sensitivity, or fearing one's own anxiety-related sensations and their potential consequences. Anxiety sensitivity has three lower-order subcomponents: physical, cognitive, and social concerns, each with individual items corresponding to fears of specific anxiety-related sensations. Less is known about relations of anxiety sensitivity at the item-level and key alcohol use variables that confer risk for negative consequences. We investigated relations between anxiety sensitivity and drinking patterns in undergraduates using latent profile analysis (LPA), which organizes individuals from a larger population into subgroups. In Aim I, we investigated subgroups of undergraduates based upon anxiety sensitivity items. The six-class solution controlling for anxiety and depression was determined to be the optimal fit. The six-class solution consisted of classes with low (Class 1) and moderate-low (Class 2) levels across all ASI-3 items, moderate-high (Class 5) and high (Class 6) levels across all ASI-3 items, moderate-low physical concerns items with moderate-high social/cognitive items (Class 3), and moderate-high physical concerns with moderate-low cognitive/social concerns (Class 4). In Aim 2, we investigated differences in these six classes in alcohol use patterns (consumption, motives, and problems), and demographics using ANOVAs and chi-square analyses. Overall, Class 6 had the most clinically severe drinking patterns. Class 1 exhibited the lowest level of alcohol use motives and problems, and had a higher proportion of individuals identifying as men and as straight in comparison to the other classes. Notably, Class 3 (7% of the sample) emerged as an important focal point for future research, due to its relation to higher coping motives for drinking, (open full item for complete abstract)

Committee: Rose Marie Ward (Committee Chair); Veronica Barrios (Committee Member); Elizabeth Kiel (Committee Member); Aaron Luebbe (Committee Member) Subjects: Clinical Psychology

Master of Arts, Miami University, 2021, Psychology

Anxiety sensitivity (AS) is the fear of consequences of anxiety-related sensations, and has been linked to the development of panic symptoms. Distress tolerance (DT) encompasses one's behavioral or self-perceived ability to handle aversive states. We examined whether higher DT buffers the relationship between AS and changes in panic symptoms across two timepoints. At Time 1, 208 participants completed a battery of questionnaires and a physical DT task (DT-physical; breath-holding duration), a cognitive DT task (DT-cognitive; anagram persistence), and a self-report measure of DT (DT-perceived). Panic symptoms were assessed at both timepoints. Structural equation modeling was used to evaluate two models across AS and DT in predicting changes of panic. Contrary to hypotheses, for those with longer breath-holding duration (higher DT-physical), higher fears of physical anxiety-related sensations (higher AS-physical) were associated with worse panic outcomes over time. Findings suggest that those with lower DT-physical may have a better capacity to disengage from difficult tasks in the short-term. Although disengagement in the short-term may provide temporary relief, it is possible that averse psychopathological consequences stemming from rigid or habitual avoidance of distressing states may develop over longer periods of time.

Committee: Elise Clerkin (Committee Co-Chair); Joshua Magee (Committee Co-Chair); Elizabeth Kiel (Committee Member); April Smith (Committee Member) Subjects: Clinical Psychology

Master of Arts, The Ohio State University, 2019, Psychology

Obesity is a major public health concern especially among African Americans who experience disproportionately higher rates of obesity and are less likely than European Americans to lose weight in weight loss interventions, possibly due to less interest in physical activity. Hence, there is a strong need for studies addressing barriers to exercise that African Americans may encounter. This study explored the degree to which anxiety sensitivity and body fat are associated with fear during exercise; and the extent to which this effect may be more pronounced in African Americans than European Americans. African American (n=30) and European American (n=34) participants with obesity (BMI ≥ 30) were recruited from the community and from among patients enrolled in Ohio State University's Living Well program. All participants completed two study conditions (i.e., exercise and reading activity). Participants in the exercise condition walked/ran on a treadmill at 70% of the age-predicted maximum heart rate reserve for 20 minutes. During the activity, participants provided ratings every four minutes of affective state, perceived exertion, and current state of distress or fear. Statistical Analysis Software (SAS) version 9.3 was used to complete all analyses. Analysis of variance (ANOVA) was used to evaluate racial group differences in anxiety sensitivity. Hierarchical regression analyses were used to evaluate the association of body fat with negative affect and perceived exertion during reading and bouts of exercise. Hierarchical regression was also used to evaluate the relationship of body fat, anxiety sensitivity, and race on mean fear in the exercise condition. Results indicated that anxiety sensitivity did not differ between African Americans and European Americans. Results also indicated a significant interaction of race, the physical subscale of anxiety sensitivity, and BMI in predicting fear response to exercise (β = 0.70, p=0.040). Among European Americans, higher BMI (open full item for complete abstract)

Committee: Charles Emery (Advisor); Michael Vasey (Committee Member); Julian Thayer (Committee Member) Subjects: Psychology

Doctor of Philosophy, University of Toledo, 2017, Psychology - Clinical

Studies examining transdiagnostic psychological constructs have increased in recent years. Transdiagnostic constructs such as rumination and anxiety sensitivity have been found to play a role in the development and maintenance of posttraumatic stress disorder (PTSD) symptoms. However, no studies to date have examined the interplay between all these constructs together and how they fluctuate in conjunction with specific clusters of PTSD symptoms. In this study, I utilized latent profile analyses in a trauma-exposed undergraduate student sample and a sample from Amazon's Mechanical Turk, to determine how levels of specific dimensions of rumination, anxiety sensitivity, and PTSD empirically group together into latent classes. Additionally, based on the number of determined classes, I assessed how constructs found to commonly co-occur with PTSD (e.g., anger, depression) differed across classes. Results showed a 4-class solution for the MTurk sample, and a 3-class solution for the student sample. Anger and depression were shown to differ significantly across classes in the MTurk sample, while only depression was found to differ significantly across classes in the student sample. Clinical implications and areas of future research of the results are discussed.

Committee: Jon Elhai (Committee Chair); Stephen Christman (Committee Member); Peter Mezo (Committee Member); Jason Levine (Committee Member); Rebecca Lusk (Committee Member) Subjects: Clinical Psychology

PhD, University of Cincinnati, 2014, Arts and Sciences: Psychology

Despite the known compromising effects of smoking on lung function and health, smoking is more common among individuals with asthma compared to those without, resulting in increased asthma symptom severity and poorer asthma control. Overall, few differences exist between smokers with and without asthma in terms of smoking behavior and smoking-related cognitive processes, thus, it is likely that there are other key factors that may help explain the association between smoking and asthma. One such factor that has received increasing empirical attention in relation to both smoking and asthma is anxiety sensitivity (AS), defined as the fear of arousal-related physical and psychological sensations. AS has been found to be associated with negative affect reduction smoking motives and greater difficulties with smoking cessation as well as poorer asthma control, and asthma-related quality of life. As research has consistently found that AS is associated with both smoking and asthma, AS may help to explain the association between smoking and asthma. Thus, the purpose of the current study was to evaluate the mediating role of AS in the association between asthma diagnosis and smoking status. The study sample consisted of four distinct groups based on asthma status and smoking status created with data from three existing datasets (N = 485): (1) 113 non-smokers without asthma (74.1% female, Mage = 20.3 years, SD = 3.7); (2) 121 non-smokers with asthma (75% female, Mage = 43.6 years, SD = 12.3); (3) 125 smokers with asthma (54% male; Mage = 37.7 years, SD = 12.1); and (4) 126 smokers without asthma (70.4% male; Mage = 36.5 years, SD = 13.1). After controlling for gender, race, and age, having an asthma diagnosis significantly predicted higher levels of AS. AS was positively associated with the log odds of being a smoker, and the direct effect of asthma diagnosis was negatively associated with smoking status. Bias-corrected bootstrapping (k = 10,000 samples) was used to generate (open full item for complete abstract)

Committee: Alison Mcleish Ph.D. (Committee Chair); Christine Hovanitz Ph.D. (Committee Member); Farrah Jacquez Ph.D. (Committee Member) Subjects: Psychology

Master of Arts, Miami University, 2011, Psychology

The current study examined the relationships among anxiety sensitivity, coping drinking motives, emotion dysregulation, and alcohol use/problems in a sample of 223 undergraduate college women drinkers. Anxiety sensitivity was indirectly related to both alcohol-related problems and alcohol use through coping motives. The indirect effect of anxiety sensitivity on alcohol-related problems (but not alcohol use) through coping motives was qualified by the level of emotion dysregulation. As individuals became more emotionally dysregulated, the strength of the relationship between coping drinking motives and alcohol-related problems increased. Results confirm the importance of emotion dysregulation in explaining alcohol-related problems and have implications for the treatment and prevention of alcohol-related problems in college women.

Committee: Terri Messman-Moore PhD (Committee Chair); Aaron Luebbe PhD (Committee Member); Garold Stasser PhD (Committee Member) Subjects: Psychology