51
|
Elwood LS, Mott J, Williams NL, Lohr JM, Schroeder DA. Attributional style and anxiety sensitivity as maintenance factors of posttraumatic stress symptoms: A prospective examination of a diathesis-stress model. J Behav Ther Exp Psychiatry 2009; 40:544-57. [PMID: 19726028 DOI: 10.1016/j.jbtep.2009.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 07/20/2009] [Accepted: 07/28/2009] [Indexed: 11/28/2022]
Abstract
Diathesis-stress models of posttraumatic stress disorder (PTSD) assert that traumatic events function as stressors that interact with vulnerabilities to influence the development of PTSD. The present study prospectively examined negative attributional style (NAS) and anxiety sensitivity (AS) as maintenance factors for PTSD in female adult sexual assault victims. A diathesis-stress model was tested by examining interactions between the vulnerabilities and negative life events. The present study included both the traditional three-factor model of PTSD (re-experiencing, avoidance and emotional numbing, and arousal) and the dysphoria four-factor model of PTSD (re-experiencing, avoidance, arousal, and dysphoria). Robust regression analyses revealed that negative life events at Time 2 significantly predicted increases in all clusters of the three-factor model (i.e., re-experiencing, avoidance and numbing, and arousal) and the re-experiencing, arousal, and dysphoria clusters of the four-factor model (but not avoidance). Neither NAS nor AS significantly independently predicted any of the symptom clusters for either model. Both NAS and AS interacted with negative life events to predict increases in the avoidance and numbing symptoms. However, examination of the dysphoria four-factor model of PTSD revealed that the NAS and AS interactions with negative life events only predicted dysphoria symptoms.
Collapse
Affiliation(s)
- Lisa S Elwood
- Department of Psychology, University of Arkansas, Fayetteville, 72701, USA.
| | | | | | | | | |
Collapse
|
52
|
McLaughlin KA, Hatzenbuehler ML. Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents. JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:659-69. [PMID: 19685962 DOI: 10.1037/a0016499] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anxiety sensitivity represents a robust risk factor for the development of anxiety symptoms among both adolescents and adults. However, the development of anxiety sensitivity among adolescents remains inadequately understood. In this study, the authors examined the role of stressful life events as a risk factor for the development of elevated anxiety sensitivity. Anxiety sensitivity was then examined in a longitudinal design as a mechanism linking stressful life events to changes in anxiety symptoms. Stressful life events, anxiety sensitivity, and internalizing symptoms were assessed in a diverse community sample of adolescents (N = 1,065) at 3 time points spanning 7 months. The results indicated that stressful life events were longitudinally associated with increases in anxiety sensitivity and that certain types of stressful life events, specifically events related to health and events related to family discord, were differentially predictive of increases in anxiety sensitivity. Moreover, anxiety sensitivity mediated the longitudinal relation between stressful life events and anxiety symptoms. Evidence was also found for the predictive specificity of anxiety sensitivity to symptoms of anxiety but not depression.
Collapse
|
53
|
Chavira DA, Stein MB, Golinelli D, Sherbourne CD, Craske MG, Sullivan G, Bystritsky A, Roy-Byrne PP. Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder. J Nerv Ment Dis 2009; 197:715-21. [PMID: 19829198 PMCID: PMC2925849 DOI: 10.1097/nmd.0b013e3181b97d4d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study's aim was to prospectively examine and identify a model of demographic, clinical, and attitudinal variables that impact improvement among patients with panic disorder. Subjects were 232 primary care patients meeting criteria for DSM-IV panic disorder. Eligible patients were randomly assigned to a collaborative care intervention or to treatment as usual. Assessments occurred at 3-month intervals during the course of 1 year. In final multivariate logistic regression models, patients with higher anxiety sensitivity and higher neuroticism scores at baseline were less likely to show clinical improvement (using a criterion of 20 or less on the Anxiety Sensitivity Index) at 3 months. Those who were non-white, had higher anxiety sensitivity, and higher overall phobic avoidance at baseline were less likely to show clinical improvement at 12 months. A greater understanding of these predictors may help clinicians identify who is at greatest risk for persistent panic-related symptoms and to plan the intensity of interventions accordingly.
Collapse
Affiliation(s)
- Denise A. Chavira
- Department of Psychiatry, University of California, San Diego, 8939 Villa La Jolla Drive, Ste. 200, La Jolla, CA 92037
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, 8939 Villa La Jolla Drive, Ste. 200, La Jolla, CA 92037,Department of Family & Preventive Medicine, University of California San Diego
| | - Daniela Golinelli
- The RAND Corporation, 1776 Main St., PO Box 2138, Santa Monica, CA 90407
| | | | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Greer Sullivan
- VA South Central Mental Illness Research Education and Clinical Center (MIRECC) and University of Arkansas for Medical Science, Little Rock
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| |
Collapse
|
54
|
Bernstein A, Zvolensky MJ, Vujanovic AA, Moos R. Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: a hierarchical model of affect sensitivity and tolerance. Behav Ther 2009; 40:291-301. [PMID: 19647530 DOI: 10.1016/j.beth.2008.08.001] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 07/29/2008] [Accepted: 08/03/2008] [Indexed: 11/29/2022]
Abstract
The purpose of the present investigation was to concurrently examine the latent dimensional and hierarchical structure of anxiety sensitivity (AS) and two key theoretically relevant and related affect (in)tolerance and sensitivity constructs: distress tolerance and discomfort intolerance. These constructs were measured using the Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Discomfort Intolerance Scale (Schmidt, Richey, & Fitzpatrick, 2006). A total of 229 individuals (124 females; M(age)=21.0 years, SD=7.5) without current Axis I psychopathology participated by completing a battery of self-report questionnaires. A two-stage exploratory factor analysis was conducted to examine the lower- and higher-order latent structural relations among the variables. The factor solution was subsequently evaluated in relation to negative affectivity, anxious arousal, and anhedonic depression. AS and distress tolerance appeared to be related to one another as distinct lower-order facets of a common higher-order affect tolerance and sensitivity factor, whereas discomfort intolerance did not appear to demonstrate similar relations with either AS or distress tolerance at the lower-order or higher-order levels. A unique pattern of association with theoretically-relevant criterion variables was observed between the affect tolerance and sensitivity higher-order factor, the AS and distress tolerance lower-order factors, and the discomfort intolerance factor. Findings are discussed in the context of theoretical and clinical implications and future directions for the study of affect tolerance and sensitivity in relation to emotional vulnerability.
Collapse
Affiliation(s)
- Amit Bernstein
- Department of Psychology, University of Haifa, Mount Carmel, Haifa, Israel.
| | | | | | | |
Collapse
|
55
|
Bernstein A, Zvolensky MJ, Zvolensky MJ, Schmidt NB. Laboratory test of a novel structural model of anxiety sensitivity and panic vulnerability. Behav Ther 2009; 40:171-80. [PMID: 19433148 DOI: 10.1016/j.beth.2008.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 04/28/2008] [Accepted: 05/15/2008] [Indexed: 11/18/2022]
Abstract
The current study evaluated a novel latent structural model of anxiety sensitivity (AS) in relation to panic vulnerability among a sample of young adults (N=216). AS was measured using the 16-item Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), and panic vulnerability was indexed by panic attack responding to a single administration of a 4-minute, 10% CO(2) challenge. As predicted, vulnerability for panic attack responding to biological challenge was associated with dichotomous individual differences between taxonic AS classes and continuous within-taxon class individual differences in AS physical concerns. Findings supported the AS taxonic-dimensional hypothesis of AS latent structure and panic vulnerability. These findings are discussed in terms of their theoretical and clinical implications.
Collapse
Affiliation(s)
- Amit Bernstein
- Department of Psychology, University of Haifa, Mount Carmel, Haifa, Israel.
| | | | | | | |
Collapse
|
56
|
Zinbarg RE, Uliaszek AA, Adler JM. The role of personality in psychotherapy for anxiety and depression. J Pers 2009; 76:1649-88. [PMID: 19012661 DOI: 10.1111/j.1467-6494.2008.00534.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A trait approach to personality has many implications for psychotherapy. Given that traits contribute to the expression of symptoms of common psychiatric disorders, are moderately heritable, and relatively stable (yet also dynamic to some extent), long-term change in symptoms is possible but is likely to be limited. Analogous to the manner in which genes set the reaction range for phenotype, standing on certain traits may set the patient's "therapeutic range." On the other hand, some of the same traits that may limit the depth of therapeutic benefits might also increase their breadth. In addition, taking the patient's standing on different traits into account can inform the choice of therapeutic strategy and targets and can affect the formation of the therapeutic alliance and compliance with self-help exercises. Finally, other aspects of personality beyond traits, such as ego development and narrative identity, also appear to have important implications for psychotherapy.
Collapse
Affiliation(s)
- Richard E Zinbarg
- Northwestern University and The Family Institute at Northwestern University, Evanston, IL 60208-2710, USA.
| | | | | |
Collapse
|
57
|
Zvolensky MJ, Stewart SH, Vujanovic AA, Gavric D, Steeves D. Anxiety sensitivity and anxiety and depressive symptoms in the prediction of early smoking lapse and relapse during smoking cessation treatment. Nicotine Tob Res 2009; 11:323-31. [PMID: 19246426 PMCID: PMC2666379 DOI: 10.1093/ntr/ntn037] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 07/27/2008] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The present investigation examined whether anxiety sensitivity, relative to anxiety and depressive symptoms, was related to duration to early smoking lapse and relapse (during first 2 weeks postquit) among daily smokers receiving smoking cessation treatment. METHODS Participants included 123 daily cigarette smokers (84 women; M(age) = 45.93 years, SD = 10.34) living in the Halifax Regional Municipality in Nova Scotia, Canada. RESULTS Anxiety sensitivity was significantly associated with an increased risk of early smoking lapse (i.e., any smoking behavior) at days 1, 7, and 14 following the quit day. Such effects were evident above and beyond the variance accounted for by gender, nicotine dependence, and nicotine withdrawal symptoms, as well as the shared variance with prequit (baseline) anxiety and depressive symptoms. In contrast to expectation, anxiety sensitivity was not related to smoking relapse (i.e., seven consecutive days of smoking) during the first 2 weeks of quitting. DISCUSSION Results are discussed in terms of better understanding the role of anxiety sensitivity, along with other affective vulnerability processes, in early problems encountered during a quit attempt.
Collapse
Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA.
| | | | | | | | | |
Collapse
|
58
|
Zvolensky MJ, Strong D, Bernstein A, Vujanovic AA, Marshall EC. Evaluation of anxiety sensitivity among daily adult smokers using item response theory analysis. J Anxiety Disord 2009; 23:230-9. [PMID: 18752924 PMCID: PMC2655129 DOI: 10.1016/j.janxdis.2008.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
The present investigation applied Item Response Theory (IRT) methodology to the 16-item Anxiety Sensitivity Index (ASI) [Reiss, S., Peterson, R. A., Gursky, M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8] for a sample of 475 daily adult smokers (52% women; M(age)=26.9, S.D.=11.1, range=18-65). Using non-parametric item response analysis, all 16 ASI items were evaluated. Evaluation of the option characteristic curves for each item revealed 4 poorly discriminating ASI items (1: "It is important not to appear nervous;" 5: "It is important to me to stay in control of my emotions;" 7: "It embarrasses me when my stomach growls;" 9: "When I notice my heart beating rapidly, I worry that I might be having a heart attack"), which were dropped from analysis. Upon repeat analysis, the remaining items appeared to make adequate separations within levels of anxiety sensitivity in this sample. Graded response modeling data indicated important differences in ASI items' capacity to discriminate between, and provide information about, latent levels of anxiety sensitivity. Specifically, three items best discriminated and provided the most information regarding latent levels of AS-items 3, 15, and 16. Items 1, 5, 7, and 9 were omitted due to their limited capacity to discriminate between latent levels of anxiety sensitivity; items 8, 12, and 13 also performed poorly. Overall, current findings suggest that evaluation of anxiety sensitivity among adult smokers using the 16-item ASI may usefully choose to focus on items that performed well in these IRT analyses (items: 2, 3, 4, 6, 10, 11, 14, 15, and 16).
Collapse
Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, VT 05405-0134, United States.
| | | | | | | | | |
Collapse
|
59
|
Neuroticism, Anxiety Sensitivity Thoughts, and Anxiety Symptomatology: Insights from an Experience-Sampling Approach. COGNITIVE THERAPY AND RESEARCH 2009. [DOI: 10.1007/s10608-009-9231-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
60
|
Zvolensky MJ, Marshall EC, Johnson K, Hogan J, Bernstein A, Bonn-Miller MO. Relations between anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations to coping and conformity marijuana use motives among young adult marijuana users. Exp Clin Psychopharmacol 2009; 17:31-42. [PMID: 19186932 PMCID: PMC3215396 DOI: 10.1037/a0014961] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The present investigation examines anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations in relation to Coping and Conformity marijuana use motives among a sample of young adult marijuana users (n = 135; 46.7% women; Mage = 20.45, SD = 5.0). After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, average volume of alcohol used over the past year, negative affectivity, and other marijuana use motives, anxiety sensitivity was significantly and uniquely associated with Coping and Conformity motives for marijuana use. Distress tolerance evidenced significant and unique incremental relations to Coping motives, whereas fear reactivity to bodily sensations was unrelated to any marijuana use motive. These results provide novel information related to the role of emotional sensitivity and tolerance factors as they pertain to specific types of motives for marijuana use among young adults.
Collapse
Affiliation(s)
| | | | | | | | | | - Marcel O Bonn-Miller
- Center for Health Care Evaluation, Veterans Affairs, Palo Alto Health Care System
| |
Collapse
|
61
|
Benítez CIP, Shea MT, Raffa S, Rende R, Dyck IR, Ramsawh HJ, Edelen MO, Keller MB. Anxiety sensitivity as a predictor of the clinical course of panic disorder: a 1-year follow-up study. Depress Anxiety 2009; 26:335-42. [PMID: 19133700 PMCID: PMC3675878 DOI: 10.1002/da.20423] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence that negative affect (NA) and anxiety sensitivity (AS) predict the development of anxiety disorders, particularly panic disorder (PD). The main purpose of this study was to examine whether NA and AS will also predict the clinical course of PD. METHODS Participants were 136 individuals with a DSM-III-R diagnosis of PD (with or without agoraphobia) enrolled in a naturalistic and longitudinal study of anxiety disorders, the Harvard/Brown Anxiety Research Project (HARP). Participants were administered the Anxiety Sensitivity Index and the Negative Affect Scales of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X-NA) and their percentage of time in PD episode was followed for 1 year after the administration of the measures. RESULTS Multiple regression analyses indicated that AS, but not NA, was a significant predictor of percentage of time in PD episode after controlling for previous time in PD episodes, comorbid depression, other anxiety disorders, and exposure to psychopharmacological and behavioral treatments. As expected, the Physical Concerns subscale of the Anxiety Sensitivity Index had a significant independent contribution in predicting the course of the disorder. CONCLUSIONS Overall, these findings suggest that AS, as a unique construct, may be predictive of the amount of time patients are in episode of PD.
Collapse
Affiliation(s)
| | | | - Susan Raffa
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
| | - Richard Rende
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
| | - Ingrid R. Dyck
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
| | - Holly J. Ramsawh
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
| | - Maria Orlando Edelen
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
| |
Collapse
|
62
|
Gonzalez A, Zvolensky MJ, Vujanovic AA, Leyro TM, Marshall EC. An evaluation of anxiety sensitivity, emotional dysregulation, and negative affectivity among daily cigarette smokers: relation to smoking motives and barriers to quitting. J Psychiatr Res 2008; 43:138-47. [PMID: 18417153 PMCID: PMC2652862 DOI: 10.1016/j.jpsychires.2008.03.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 03/04/2008] [Accepted: 03/04/2008] [Indexed: 11/24/2022]
Abstract
The present investigation evaluated the relations between anxiety sensitivity and motivational bases of cigarette smoking, as well as barriers to quitting smoking, above and beyond concurrent substance use, negative affectivity, and emotional dysregulation among a community sample of 189 daily cigarette smokers (46% women; M(age)=24.97 years, SD=9.78). Results indicated that anxiety sensitivity was significantly related to coping, addictive, and habitual smoking motives, as well as greater perceived barriers to quitting. These effects were evident above and beyond the variance accounted for by concurrent tobacco, alcohol, and marijuana use and discernable from shared variance with negative affectivity and emotional dysregulation. Emotional dysregulation was significantly related to stimulation, habitual, and sensorimotor smoking motives and greater perceived barriers to quitting, whereas negative affectivity was only significantly related to smoking for relaxation. These findings uniquely add to a growing literature suggesting anxiety sensitivity is an important and unique cognitive factor for better understanding clinically-relevant psychological processes related to cigarette smoking.
Collapse
|
63
|
Escocard MRPG, Fioravanti-Bastos ACM, Landeira-Fernandez J. Anxiety Sensitivity Factor Structure Among Brazilian Patients with Anxiety Disorders. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2008. [DOI: 10.1007/s10862-008-9103-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
64
|
Leyro TM, Zvolensky MJ, Vujanovic AA, Bernstein A. Anxiety sensitivity and smoking motives and outcome expectancies among adult daily smokers: replication and extension. Nicotine Tob Res 2008; 10:985-94. [PMID: 18584462 DOI: 10.1080/14622200802097555] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present investigation examined the incremental validity of anxiety sensitivity in the context of distress intolerance in terms of predicting smoking motives and outcome expectancies. Participants were a community sample of 144 daily smokers (85 women, M (age) = 29.72 years, SD = 11.96). Results indicated that above and beyond discomfort intolerance, Axis I diagnoses, gender, volume of alcohol consumption, and average number of cigarettes smoked per day, anxiety sensitivity significantly incrementally predicted habitual, addictive, and negative affect reduction motives to smoke, as well as negative reinforcement outcome expectancies. No such incremental effects were similarly evident for distress intolerance. Findings are discussed in relation to the role of anxiety sensitivity in smoking motives and outcome expectancies.
Collapse
|
65
|
Story TJ, Craske MG. Responses to false physiological feedback in individuals with panic attacks and elevated anxiety sensitivity. Behav Res Ther 2008; 46:1001-8. [DOI: 10.1016/j.brat.2008.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 06/05/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
|
66
|
Vujanovic AA, Zvolensky MJ, Bernstein A. Incremental associations between facets of anxiety sensitivity and posttraumatic stress and panic symptoms among trauma-exposed adults. Cogn Behav Ther 2008; 37:76-89. [PMID: 18470739 DOI: 10.1080/16506070801969039] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present investigation examined incremental associations between anxiety sensitivity (AS) subfactors (e.g. physical, psychological, and social concerns) and posttraumatic stress and panic symptoms among trauma-exposed adults. These effects were examined above and beyond other theoretically relevant factors, including negative affectivity and number of types of trauma exposures. The 239 participants were selected from a university- and community-based sample (129 women; mean age = 23.0 years; SD = 9.6, range = 18-65), all of whom endorsed exposure to traumatic life events. The AS psychological concerns and AS physical concerns lower order factors evidenced distinct associations with posttraumatic stress symptoms and panic-relevant symptoms, respectively. Specifically, the AS psychological concerns facet was significantly incrementally predictive of posttraumatic stress-relevant avoidance symptoms. The AS physical concerns facet was significantly incrementally predictive of panic-relevant symptoms, including anxious arousal, body vigilance, and perceived control over anxiety-related events. Results are discussed in the context of the relevant theoretical literature pertaining to shared vulnerability and comorbidity between posttraumatic stress and panic.
Collapse
Affiliation(s)
- Anka A Vujanovic
- Department of Psychology, University of Vermont, Burlington, VT 05405-0134, USA
| | | | | |
Collapse
|
67
|
Wald J, Taylor S. Responses to interoceptive exposure in people with posttraumatic stress disorder (PTSD): a preliminary analysis of induced anxiety reactions and trauma memories and their relationship to anxiety sensitivity and PTSD symptom severity. Cogn Behav Ther 2008; 37:90-100. [PMID: 18470740 DOI: 10.1080/16506070801969054] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A growing body of evidence suggests that anxiety sensitivity (AS; fear of arousal-related sensations) plays a role in posttraumatic stress disorder (PTSD). Consistent with this, evidence indicates that interoceptive exposure (IE), which is a method for reducing AS, reduces PTSD symptoms. Clinical observations from our treatment studies indicate that IE triggers both anxiety and trauma memories in people with PTSD. The primary aim of this study was to describe the anxiety responses to a series of IE exercises and to examine whether or not trauma memories were activated. A secondary aim was to explore the relationships among AS, PTSD symptom severity, and IE responses. Data were collected from 23 people with PTSD who completed measures of PTSD symptoms and AS and a standardized battery of 10 IE exercises. Elevated anxiety and strong arousal responses were frequently elicited by the exercises, and trauma memories were also frequently triggered. AS and IE-triggered trauma memories significantly predicted IE-induced peak anxiety. The implications of the findings are discussed in terms of how IE might exert its therapeutic effects in the treatment of PTSD.
Collapse
Affiliation(s)
- Jaye Wald
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | | |
Collapse
|
68
|
Gregor KL, Zvolensky MJ. Anxiety sensitivity and perceived control over anxiety-related events: evaluating the singular and interactive effects in the prediction of anxious and fearful responding to bodily sensations. Behav Res Ther 2008; 46:1017-25. [PMID: 18675954 DOI: 10.1016/j.brat.2008.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 06/03/2008] [Accepted: 06/04/2008] [Indexed: 11/18/2022]
Abstract
The present investigation examined the singular and interactive effects of anxiety sensitivity and perceived control over anxiety-related events in the prediction of panic symptoms using a CO(2)-enriched air biological challenge. Two hundred and twenty-nine adult participants (M(age)=21.02, SD=7.55, 124 females) were recruited from the greater Burlington, Vermont community. Results indicated that pre-challenge anxiety sensitivity, but not perceived control over anxiety-related events, significantly predicted post-challenge panic attack symptoms, anxiety focused on bodily sensations, and, interest in returning for another challenge (behavioral avoidance). In regard to physiological findings, anxiety sensitivity was significantly related to skin conductance level whereas perceived control over anxiety-related events was related to respiration rate. Neither anxiety sensitivity nor perceived control over anxiety-related events was related to heart rate. There also were no interactive effects between anxiety sensitivity and perceived control over anxiety-related events for any of the studied dependent variables. Results are discussed in relation to multi-risk factor models of cognitive vulnerability for panic psychopathology.
Collapse
Affiliation(s)
- Kristin L Gregor
- Department of Psychology, University of Vermont, John Dewey Hall, Burlington, VT 05405, USA
| | | |
Collapse
|
69
|
Olatunji BO, Feldner MT, Karekla M, Forsyth JP. A comparative evaluation of panicogenic processes and quality of life in a sample of non-clinical panickers and age and sex matched non-panicking controls. J Anxiety Disord 2008; 22:175-86. [PMID: 17383152 DOI: 10.1016/j.janxdis.2007.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/14/2007] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
Contemporary models of panic attacks suggest that panic problems exist on a continuum and highlight the need to understand what differentiates persons who have never had a panic attack versus persons who have had panic attacks but have not yet developed panic disorder (i.e., non-clinical panickers). Accordingly, the present study evaluated several theoretically-relevant factors that were expected to distinguish a sample of (conservatively defined) non-clinical panickers (n=72) from an age and sex-matched comparison sample of non-panicking controls (n=72). As expected, panickers were characterized by higher levels of anxiety sensitivity, perceived uncontrollability, and state and trait anxiety relative to their non-panic counterparts. Moreover, higher levels of trait anxiety emerged as a predictor of poorer quality of life among panickers. Results are considered within the context of biopsychosocial continuum models of panic attacks and panic disorder and future directions for research are suggested.
Collapse
Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, TN 37203, USA.
| | | | | | | |
Collapse
|
70
|
McLeish AC, Zvolensky MJ, Yartz AR, Leyro TM. Anxiety sensitivity as a moderator of the association between smoking status and anxiety symptoms and bodily vigilance: replication and extension in a young adult sample. Addict Behav 2008; 33:315-27. [PMID: 17967508 PMCID: PMC2213627 DOI: 10.1016/j.addbeh.2007.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Revised: 08/17/2007] [Accepted: 09/20/2007] [Indexed: 11/13/2022]
Abstract
The present investigation evaluated the moderational role of the physical concerns dimension of anxiety sensitivity (fear of anxiety and anxiety-related states) in the relation between smoking status and panic-relevant symptoms in a young adult sample (n=222; 123 females; M(age)=22.45 years, SD=8.08). Consistent with prediction, anxiety sensitivity physical concerns moderated the association of smoking status with body vigilance and anxious arousal symptoms, such that greater anxiety sensitivity physical concerns was associated with greater panic symptoms among smokers. The observed effects were evident even after controlling for the variance accounted for by alcohol use problems and gender. Also consistent with prediction, there was no interactive effect apparent for depressive symptoms, providing evidence of explanatory specificity with respect to the anxiety variables examined. Findings are discussed with regard to the role of anxiety sensitivity in the relation between smoking and panic processes.
Collapse
Affiliation(s)
- Alison C. McLeish
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS 39216, United States
| | - Michael J. Zvolensky
- The University of Vermont, Department of Psychology, 2 Colchester Ave., Burlington, VT 05405-0134, United States
| | - Andrew R. Yartz
- The University of Vermont, Department of Psychology, 2 Colchester Ave., Burlington, VT 05405-0134, United States
| | - Teresa M. Leyro
- The University of Vermont, Department of Psychology, 2 Colchester Ave., Burlington, VT 05405-0134, United States
| |
Collapse
|
71
|
Abstract
There has been a long-standing recognition that cognitive factors may play a formative role in anxiety and its disorders (Barlow, 2002). Since the 1980s, there has been great progress made in understanding the nature of cognitive risk for anxiety psychopathology. Within this context, numerous cognitive factors have been implicated and studied as potential risk factors for various anxiety conditions. Perhaps one of the most well-known and promising of these has been anxiety sensitivity (AS; Reiss & McNally,1985). AS is the fear of anxiety-related bodily sensations, which arise from beliefs that the sensations have harmful personal consequences (McNally,2002). To illustrate, people high in AS may be frightened of harmless heart palpitations because they believe the sensations will lead to cardiac arrest,whereas people low in AS do not fear these sensations because they believe them to be harmless. High AS is theorized to enhance anxious and fearful responding to internal cues through associative learning and/or cognitive misinterpretation (McNally, 2002). Numerous studies have indicated that AS is, in fact, related to increased risk of panic attacks (e.g., Hayward, Killen, Kraemer, & Taylor, 2000; Schmidt, Lerew, & Jackson, 1997, 1999) and anxiety disorders (Schmidt, Zvolensky, & Maner, 2006). Although the vast majority of work on AS has been conducted in relation to panic psychopathology (Zvolensky, Schmidt, Bernstein, & Keough, 2006), researchers
Collapse
Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, Burlington, VT 05405-0134, USA.
| | | |
Collapse
|