Anxiety sensitivity: prospective prediction of panic attacks and Axis I pathology

Role of interoceptive fear and maladaptive attention and behaviors in the escalation of psychopathology-a network analysis

The complex interplay of fear, attention, and behavior toward bodily sensations with psychopathological symptoms and how they mutually influence and potentially reinforce one another remains to be fully elucidated. In this study, we used a network analytical approach to unravel these complex interactions. Specifically, we aimed to identify central symptoms and etiologically relevant factors that might be associated with anxiety and depressive core symptoms. To this end, the following clusters were assessed in 791 adults: interoceptive fear, interoceptive attention, maladaptive behaviors related to bodily sensations, and core symptoms of anxiety and depression. This network was modeled using a Gaussian Graphical Model. Central variables (nodes) were identified using centrality indices and bridge analysis. Self-examination and attention to bodily sensations emerged as central nodes. Moreover, time spent paying attention to bodily sensations, fear of anxiety-related sensations, and self-examination were identified as central bridge nodes, that is, central nodes connecting psychopathologically relevant symptom clusters. The present study indicates that fear of bodily sensations, the amount of attention and time spent focusing on somatic sensations, and self-examination are central factors. The findings suggest potential targets for future longitudinal studies on the impact of these factors for the escalation of anxiety and depressive symptoms.

Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors

OBJECTIVE

Eating disorders (EDs) represent a rising global health concern. The current study takes a multivariate approach to examine psychological (i.e., perfectionism, anxiety sensitivity [AS], emotion dysregulation) and sociocultural factors (i.e., body dissatisfaction) that may relate to risk and resilience in EDs.

METHODS

Participants were 698 undergraduate students (Mage = 21, SDage = 4.02), mainly female (71%) and Hispanic (61.6%), who participated in an online survey assessing perfectionism, emotion dysregulation, AS, body dissatisfaction, and eating behaviors.

RESULTS

The results from structural equation model analyses revealed differential associations with disordered eating (DE) outcomes. Self-oriented perfectionism and dysmorphic appearance concerns were associated with increased dieting/carb restriction, desire for thinness, and binging tendencies. Specifically, emotional nonacceptance and lack of emotional awareness showed associations with elevated risk for dieting/carb restriction and purging tendencies, respectively. Conversely, lack of emotional clarity showed a protective pathway to these risk behaviors. Anxiety sensitivity cognitive concerns related to higher purging tendencies, while AS social concerns related to lower purging and binging tendencies.

DISCUSSION

Findings highlight the differential pathways of psychosocial risk and resilience for EDs. Subscales of emotional dysregulation and AS showed risk as well as resilience associations with DE outcomes. This information is key for advancing transdiagnostic prevention and intervention to reduce the rising rates of EDs.

Brief observable anxiety sensitivity treatment: intervention development and a pilot randomized-controlled acceptability and feasibility trial to evaluate a brief intervention for anxiety sensitivity social concerns

Social anxiety disorder is one of the most prevalent anxiety disorders. There is a need to develop brief, virtual, single-session interventions targeting constructs associated with social anxiety, such as anxiety sensitivity social concerns (ASSC). ASSC is the maladaptive belief about consequences arising from observable symptoms of anxious arousal. This study was designed to evaluate the initial acceptability and feasibility of a brief ASSC reduction program (Brief Observable Anxiety Sensitivity Treatment [BOAST]) which included a single clinician-led intervention session followed by a two-week ecological momentary intervention (EMI), delivered via mobile app. Participants (N = 36) were adults with elevated ASSC who were randomly assigned to receive BOAST (n = 19) or a waitlist control (n = 17). The trial was prospectively registered at clinicaltrials.gov (NCT04859790). Results supported the acceptability of BOAST with mixed findings for feasibility. Feasibility metrics for the EMI component were below pre-defined thresholds; however, there was evidence that homework completion was associated with symptom reduction. Preliminary efficacy metrics indicated that participants in the BOAST condition had large reductions in ASSC and one measure of social anxiety at 1-month follow-up. This study provides preliminary support for the acceptability of BOAST and elucidates avenues for future clinical and research efforts.

Reciprocal and Indirect Effects Among Intervention, Perceived Social Support, and Anxiety Sensitivity Within a Randomized Controlled Trial for Anxiety Disorders

Social support may facilitate adaptive reappraisal of stressors, including somatic symptoms. Anxiety sensitivity refers to negative beliefs about somatic symptoms of anxiety, which may influence one's perception of social support. Evidence-based treatment may impact these associations. The current longitudinal study evaluated reciprocal relationships between perceived social support and anxiety sensitivity, and explored indirect intervention effects, in a randomized controlled trial for anxiety disorders that compared cognitive behavioral therapy with or without medications (CALM) to usual care. Data collected over 18 months from 940 primary care patients were examined in random intercept cross-lagged panel models. There were significant reciprocal associations between perceived social support increases and anxiety sensitivity decreases over time. There were significant indirect effects from intervention to perceived social support increases through anxiety sensitivity decreases and from intervention to anxiety sensitivity decreases through perceived social support increases. These data suggest that, relative to usual care, CALM predicted changes in one construct, which predicted subsequent changes in the other. Secondary analyses revealed an influence of anxiety and depressive symptoms on reciprocal associations and indirect effects. Findings suggest that future treatments could specifically address perceived social support to enhance reappraisal of somatic symptoms, and vice versa.

Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis

OBJECTIVE

Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis.

METHOD

We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity).

RESULTS

Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective.

CONCLUSIONS

Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed.

Associations between sleep disturbance, physical activity, and anxiety sensitivity among college students during the COVID-19 pandemic

The present study sought to examine associations between anxiety sensitivity and both sleep and physical activity among college students, who are particularly vulnerable to sleep disturbance, decreased physical activity, and the development of psychopathology, especially in the wake of the COVID-19 pandemic. Participants were 683 college students (Mage = 20.33, SD = 3.58; 72% female; 70.3% White) who completed self-report measures online for course credit. Results indicated that after controlling for the effects of age, gender identity, and race, greater sleep disturbance was significantly associated with higher overall anxiety sensitivity (7% unique variance; β = 0.27, t = 6.67, p < .001) as well as its three subdomains (physical concerns: 4% variance; β = 0.21, t = 4.97, p < .001; cognitive concerns: 6% variance; β = 0.25, t = 6.17, p < .001; social concerns: 6% variance; β = 0.26, t = 6.22, p < .001). Additionally, more time spent walking was associated with greater anxiety sensitivity physical concerns (1% variance; β = 0.11, t = 2.52, p = .012) and greater vigorous intensity physical activity was associated with lower anxiety sensitivity social concerns (1% variance; β = -0.13, t = -2.76, p = .006). These findings suggest that sleep problems may be more universally relevant to anxiety sensitivity than physical activity and interventions to promote healthier sleep may be useful for decreasing anxiety sensitivity in college students.

An examination of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in adults in routine psychiatric care

AIM

A person's ability to tolerate negative emotional states (Distress Tolerance - DT), uncertainty in their everyday lives (Intolerance of Uncertainty - IU), and a tendency to appraise their own feelings of anxiety as harmful (Anxiety Sensitivity - AS) have all been identified as vulnerability factors for anxiety and depressive disorders. However, the relationship between these variables and broader aspects of psychiatric symptom severity in participants recruited from routine care remains unclear.

METHOD

The Distress Tolerance Scale (DTS), Anxiety Sensitivity Scale-3 (ASI-3), and Intolerance of Uncertainty Scale-Short Form (IUS-12) were administered to 91 patients receiving treatment at the Lund Outpatient Psychiatric Clinic. Data was collected from their medical records about their psychiatric history and scores on the Brief Symptom Inventory (BSI). The relationship between total scores on the DTS, ASI-3, IUS-12 and BSI were evaluated via correlations and regression analyses.

RESULTS

DTS, ASI-3, and IUS-12 total scores correlated in the moderate to large range, and consistent with previous literature, were moderately to strongly correlated with the severity of self-reported depression, anxiety and overall symptoms (BSI). Regression analyses indicated that together, scores on the DTS, ASI-3 and IUS-12 explained moderate levels of variance in BSI symptom scores, with DTS scores showing the strongest associations. These findings suggest that further studies are needed to examine the construct and criterion validity of the three scales. Further validation of these Swedish-language are also warranted.

Anxiety sensitivity elevates the risk of mental health problems in employees with higher probability of contacting COVID-19 at work

Individuals with increased risk of being in contact with COVID-19 cases at work have been reported to suffer from higher fear of infection and associated mental health problems. The present study examines whether this risk is further increased by higher anxiety sensitivity (AS, i.e., fear of bodily symptoms such as breathlessness, which also are core symptoms of COVID-19) that is also known to be associated with an increased risk of psychopathology. In spring 2020, 783 German health care and social workers participated in a cross-sectional online-survey, in which anxiety sensitivity, depression, anxiety, health anxiety, fear of a COVID-19 infection as well as panic symptoms were assessed. Of these participants, 28.7% affirmed contact with COVID-19 cases, which was associated with greater fear of the virus. Individuals with high AS reported more severe anxiety, health anxiety, depressive symptoms, as well as incident and recurrent panic symptoms. Moreover, the risk association of exposure to COVID-19 cases at work with health anxiety, general anxiety, and panic symptoms was further increased by higher levels of AS. These findings suggest that especially employees with contact to COVID-19 cases who also are high in AS might profit from targeted interventions to prevent excessive fear and associated mental health problems.

Incremental Validity of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy Mechanisms for Anxiety and Panic Symptomology

Background: acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) are empirically supported treatments for anxiety and panic disorder (PD), though they differ in their putative vulnerability and maintenance processes. The present study examined the incremental validity of several of these models' proposed core processes, including anxiety sensitivity (AS), dispositional avoidance, experiential avoidance (EA), cognitive fusion (CF), and mindfulness, as well as the interaction of the processes within each model, in the prediction of anxiety and panic symptomology. Methods: a sample of US adults (n = 316) completed self-report measures of AS, dispositional avoidance, EA, CF, mindfulness, anxiety, and PD symptoms. A series of hierarchical multiple regression analyses were conducted. Results: hierarchical regression analyses indicated that AS, dispositional avoidance, and EA predicted anxiety and panic symptoms even after controlling for one another, CF, mindfulness, and demographic variables. Although mindfulness and CF was correlated with anxiety and panic at the univariate level, they did not predict either outcome above and beyond AS, dispositional avoidance, and EA. When interaction terms were added to the models, the interaction between AS and -dispositional avoidance was a significant predictor of panic and anxiety symptoms, whereas the interaction between EA and CF only predicted panic symptoms. None of the interactions that included mindfulness were significant predictors. Conclusions: these findings provide support the independent and interactive predictive value of traditional CBT (AS, dispositional avoidance, and AS-dispositional avoidance) and ACT (EA) processes for anxiety and panic symptoms, but raise questions about the incremental predictive utility of CF and mindfulness.

Anxiety onset in adolescents: a machine-learning prediction

Recent longitudinal studies in youth have reported MRI correlates of prospective anxiety symptoms during adolescence, a vulnerable period for the onset of anxiety disorders. However, their predictive value has not been established. Individual prediction through machine-learning algorithms might help bridge the gap to clinical relevance. A voting classifier with Random Forest, Support Vector Machine and Logistic Regression algorithms was used to evaluate the predictive pertinence of gray matter volumes of interest and psychometric scores in the detection of prospective clinical anxiety. Participants with clinical anxiety at age 18-23 (N = 156) were investigated at age 14 along with healthy controls (N = 424). Shapley values were extracted for in-depth interpretation of feature importance. Prospective prediction of pooled anxiety disorders relied mostly on psychometric features and achieved moderate performance (area under the receiver operating curve = 0.68), while generalized anxiety disorder (GAD) prediction achieved similar performance. MRI regional volumes did not improve the prediction performance of prospective pooled anxiety disorders with respect to psychometric features alone, but they improved the prediction performance of GAD, with the caudate and pallidum volumes being among the most contributing features. To conclude, in non-anxious 14 year old adolescents, future clinical anxiety onset 4-8 years later could be individually predicted. Psychometric features such as neuroticism, hopelessness and emotional symptoms were the main contributors to pooled anxiety disorders prediction. Neuroanatomical data, such as caudate and pallidum volume, proved valuable for GAD and should be included in prospective clinical anxiety prediction in adolescents.

The association between anxiety sensitivity and food cravings among individuals seeking treatment for weight-related behaviors

BACKGROUND

A better understanding of risk-factors associated with state-like food cravings may be one clinically relevant component in an effort to better understand obesity. Existing work has shown anxiety sensitivity (AS) to be a significant risk factor for increased cravings across a variety of health behaviors (e.g., smoking, alcohol use). Yet, no work has examined the relationship between AS and state-like food cravings. Therefore, the current study sought to examine the association between AS and a variety of state-like food cravings, including: (1) an intense desire to eat, (2) anticipation of relief from negative states and feelings/improvement in mood that may result from eating, (3) obsessive preoccupation with food or lack of control over eating, and (4) craving as a physiological state.

METHODS

Participants included 161 (Mage = 31.58, SD = 10.71; 60.9 % female) individuals seeking treatment for weight-related behaviors.

RESULTS

Results indicated that elevated AS was associated with reinforcement-based and physiological food cravings.

CONCLUSION

Our findings indicate that there may be clinical utility in screening for AS among individuals seeking treatment for weight-related behaviors in efforts to better understand specific types of food craving.

Psychological Correlates of Health anxiety in Response to the Coronavirus (COVID-19) Pandemic: a Cross-Sectional Online Study in Iran

Current models suggest health anxiety as a fundamental variable associated with fear and anxiety related to COVID-19. The investigation was carried out in separate two studies on the Iranian population. The first study aims to test the COVID-19 Anxiety Inventory (N = 202). The findings indicate a two-factor structure of the scale. Participants (N = 1638) completed the online survey anonymously in the second study, including the COVID-19 Anxiety Inventory, Short Health Anxiety Inventory, The Intolerance of Uncertainty Scale, Anxiety Sensitivity Index-3, Body Vigilance Scale, Depression Anxiety Stress Scales 21, and Contamination Cognitions Scale. Results showed that health anxiety, anxiety sensitivity, and body vigilance would significantly contribute to fears of contracting COVID-19. Moreover, the findings support a central role of intolerance of uncertainty in predicting COVID-19 anxiety. The study results provided both theoretical and practical implications for understanding psychosocial predictors during the COVID-19 pandemic.

A preliminary examination of the Anxiety Sensitivity Index-3 factor structure in older adults

BACKGROUND

Anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3), exhibits three-factor and bifactor structures for younger adults. Less is known about the scale's structure within older adult samples.

METHODS

We explored the ASI-3's factor structure in a sample of 135 older adults who completed the ASI-3 alongside measures of anxiety, general worry, dementia worry, and depression as part of a larger study. Structural equation modeling was used to determine the factor structure of the ASI-3 in this sample.

RESULTS

A bifactor model was identified and factor loadings supported a general factor and specific physical and cognitive subfactors, but not the social concerns subfactor. Whereas the general factor was associated with anxiety, general worry, dementia worry, and depression, each subfactor had differential associations with these mood/anxiety variables. In particular, the cognitive concerns subfactor was strongly associated with depression and dementia worry.

LIMITATIONS

Generalizability of these findings is limited by a homogenous sample.

CONCLUSIONS

The observed factor structure of the ASI-3 in our sample aligns with increases in physical and cognitive health concerns during aging. Associations between the cognitive concerns subfactor and dementia worry suggest that this facet of the ASI-3 may be measuring age-related health concerns rather than concerns specific to anxiety symptoms. Future studies should examine whether AS cognitive concerns and dementia worry are overlapping constructs particularly for individuals concerned about their age-related cognitive changes. Age differences in AS and its correlates should be further studied to identify better methods of assessing for AS across the lifespan.

Anxiety Sensitivity Social Concerns Predicts Electrodermal Activity during the Niacin Biological Challenge Paradigm

Anxiety sensitivity social concerns (ASSC), or the fear of observable anxiety symptoms, is a risk factor for social anxiety. ASSC predicts anxiety following the niacin biological challenge, a paradigm in which niacin is used to manipulate facial flushing during a speech task. However, it remains unclear if ASSC predicts physiological arousal during this task. The current study was designed to examine the effects of ASSC on self-reported distress and electrodermal activity (EDA) during the niacin biological challenge in a sample of undergraduates (N = 36; M age = 18.9, SD = 0.84; 69.4% female). Participants were randomly assigned to one of four conditions in a 2 (100 mg niacin vs. 100 mg sugar) × 2 (instructional set) design. Participants completed a speech task in a virtual reality environment. Participants rated their distress halfway through the speech and EDA was averaged over four intervals. There was a main effect for ASSC on subjective distress. There was a significant ASSC by condition interaction predicting EDA, in that ASSC was related to EDA only in the niacin condition. ASSC also was more strongly related to EDA anticipating the speech. These findings highlight the role of ASSC in predicting anxiety and physiological arousal.

Changes in Internalizing Symptoms and Anxiety Sensitivity Among College Students During the COVID-19 Pandemic

The early months of the COVID-19 pandemic saw significant increases in symptoms of anxiety and depression, particularly among college students. However, research has not examined how internalizing symptoms in this population have changed as the pandemic has continued into its second year. Further, there has yet to be an examination of potential changes in transdiagnostic vulnerability factors. Therefore, the purpose of the current repeated cross-sectional study was to examine differences by term in undergraduates’ symptoms of depression, anxiety, worry, social anxiety, and anxiety sensitivity in the Spring 2020 (n = 251), Fall 2020 (n = 427), and Spring 2021 (n = 256) semesters. Results indicated that there were significant increases in depression, anxiety, worry, and anxiety sensitivity from Spring 2020 to Fall 2020 that were maintained through the Spring 2021 semester, and levels of social anxiety were significantly higher in Spring 2021 compared to Spring 2020. These findings suggest that the mental health impacts of the COVID-19 pandemic on college students have continued beyond the initial months, and colleges and universities will need to develop comprehensive plans to adequately address college students’ mental health needs.

Baroreflex sensitivity derived from the Valsalva manoeuvre: A physiological protective factor for anxiety induced by breathing CO2-enriched air

This study aimed to determine the capacity of baroreflex sensitivity, derived from the Valsalva manoeuvre (BRS_v), to predict state anxiety induced by a biological stressor (CO₂ inhalation). Healthy adults (n = 50) breathed 7.5 % CO₂-enriched air for 8 min, preceded and followed by breathing medical air for 5 min. State anxiety was evaluated with a visual analogue scale. Anxiety sensitivity (Anxiety Sensitivity Index-3; ASI-3) and trait anxiety (Trait form of the State-Trait Anxiety Inventory; STAI_T) served as cognitive-affective predictors. BRS_v was adopted as a physiological predictor. Multiple regression analysis revealed that BRS_v predicted lower anxiety during CO₂ exposure, and attenuated the effect of ASI-3 in increasing anxiety. No significant effects were found for STAI_T. This is the first study to identify baroreflex sensitivity as a strong protective physiological factor for anxiety beyond the effect of anxiety sensitivity.

The Interactive Effect of Anxiety Sensitivity and Metacognitive Beliefs on Anxiety

Anxiety sensitivity (AS) has been identified as a contributing factor to the development and maintenance of anxiety. Individuals with high AS are sensitive to bodily cues and anxiety-related thoughts and often misinterpret these stimuli as catastrophic or dangerous. Similarly, negative and positive metacognitive beliefs (i.e., beliefs about thinking) are believed to increase internal threat monitoring and the use of maladaptive coping strategies, which may increase the impact of AS on anxiety. As such, the purpose of the present study was to examine the moderating role of metacognitive beliefs on the relationship between anxiety sensitivity and anxiety. Adult participants (N = 417), recruited through an online crowdsourcing website, completed a battery of measures assessing the constructs of interest. Results from multiple linear regression indicated that the relationship between AS and anxiety became significantly stronger as negative and positive metacognitive beliefs increased, thus suggesting that negative and positive metacognitive beliefs may exacerbate the effect of AS on anxiety. The development of risk profiles that incorporate AS and negative and positive metacognitive beliefs may be beneficial for early identification of individuals at high risk for the development of anxiety.

Computer-delivered intervention for individuals with obesity and elevated anxiety sensitivity: feasibility, acceptability, and initial test

Obesity is one the fastest growing public health problems related to numerous chronic diseases and frequently co-occurs with negative mood states. One promising approach to address the heterogeneity of affective vulnerabilities and obesity is to focus on processes (e.g. anxiety sensitivity [AS]) that underpin both conditions. Thus, this study aimed to evaluate the feasibility, acceptability, and initial efficacy of a brief, computer-delivered AS reduction program (AST) for adults with obesity and elevated AS. Participants were 131 individuals with obesity and elevated AS who received either AST or a health information control (HC). Latent growth curve modeling was utilized to examine the effect of treatment condition on change in AS, emotional eating, expectancies of eating to manage mood, and exercise self-efficacy from baseline to 1-week, 2-weeks, and 1-month follow-up. Results indicated it was feasible to recruit and retain individuals with obesity and elevated AS through the 1-month follow-up. Positive qualitative feedback was also provided for both AST and HC. AST was a statistically significant predictor of change in expectancies of eating to manage negative affect. No other statistically significant treatment effects were indicated. Current data provide initial empirical support for future work focused on persons with obesity and elevated AS.

Anxiety and depressive symptoms among adults with obesity and chronic pain: the role of anxiety sensitivity

Obesity and chronic pain frequently co-occur, and this co-occurrence can have potential negative consequences, particularly as it relates to mental health. As such, there is a need to understand potential risk factors for poor mental health among this co-morbid population. Thus, the current study examined the predictive role of anxiety sensitivity (and its sub-facets) on anxiety and depressive symptoms among adults (82.5% female, M_age = 40.2 years, SD = 10.92) with obesity and chronic pain. Results revealed that greater levels of anxiety sensitivity were associated with greater levels of both anxiety and depressive symptoms, with medium to large effect sizes. Post hoc analyses also indicated that specific sub-facets of anxiety sensitivity (cognitive and social concerns) were significant predictors of the criterion variables. The current study highlights the potential clinical utility in targeting anxiety sensitivity among individuals with co-occurring obesity and chronic pain in the treatment of anxiety and depressive symptoms.

The cognitive anxiety sensitivity treatment (CAST) in anxiety prevention - Focus on separation anxiety and interoception

Given the high prevalence and considerable clinical and societal burden of anxiety disorders, preventive measures are urgently warranted to reduce their incidence and overall healthcare impact. Anxiety sensitivity (AS) - a key element in learning theories of anxiety disorders in the context of interoceptive conditioning - constitutes a malleable risk factor of particularly panic disorder and separation anxiety, which share developmental, nosological, epidemiological and pathomechanistic characteristics. The computer-assisted 'Cognitive Anxiety Sensitivity Treatment' (CAST) targeting interoceptive anxiety symptoms (cf. Schmidt et al., 2014) was translated, intensified and culturally adapted to German and evaluated in a sample of 105 healthy adult volunteers with elevated AS (mean ASI-3: 29.5) applying a randomized design. Success of the intervention was measured as a function of AS and separation anxiety (ASA-27) ∼6 weeks (T1) and ∼6 months (T2) after the intervention. As compared to waitlist, CAST resulted in a significant reduction of AS at both T1 and T2. Separation anxiety was not directly reduced by the intervention, but decreased mediated by a decline in AS. A composite interoceptive score capturing changes in sensitivity to respiratory symptoms during the baseline therapist-accompanied CAST session was shown to be predictive of overall response at T1. In sum, CAST-German Version was successfully established as an effective intervention reducing AS, while at the same time indirectly decreasing separation anxiety. A composite interoceptive score predicting treatment response might aid in further delineating risk markers informing targeted preventive interventions for anxiety disorders.

Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions

Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.

Contextual modulation of conditioned responses in humans: A review on virtual reality studies

Conditioned response (CRs) triggered by stimuli predicting aversive consequences have been confirmed across various species including humans, and were found to be exaggerated in anxious individuals and anxiety disorder patients. Importantly, contextual information may strongly modulate such conditioned responses (CR), however, there are several methodological boundaries in the translation of animal findings to humans, and from healthy individuals to patients. Virtual Reality (VR) is a useful technological tool for overcoming such boundaries. In this review, we summarize and evaluate human VR conditioning studies exploring the role of the context as conditioned stimulus or occasion setter for CRs. We observe that VR allows successful acquisition of conditioned anxiety and conditioned fear in response to virtual contexts and virtual cues, respectively. VR studies also revealed that spatial or temporal contextual information determine whether conditioned anxiety and conditioned fear become extinguished and/or return. Novel contexts resembling the threatening context foster conditioned fear but not conditioned anxiety, suggesting distinct context-related generalization processes. We conclude VR contexts are able to strongly modulate CRs and therefore allow a comprehensive investigation of the modulatory role of the context over CR in humans leading to conclusions relevant for non-VR and clinical studies.

Anxiety sensitivity prospectively predicts pandemic-related distress

BACKGROUND

Anxiety sensitivity (AS) is a well-studied transdiagnostic risk construct that is believed to amplify responses to many forms of stress. The COVID-19 pandemic is a broad stressor with significant physical and social threats. In the current study, we were interested in ascertaining the degree to which AS would relate to distress and disability in the context of COVID-19. We hypothesized that AS would be associated with increased distress and disability. Moreover, we hypothesized that AS would be uniquely predictive while controlling for other relevant risk factors such as age, race, and perceived local COVID-19 infection rates.

METHOD

Participants (N = 249) were U.S. adults assessed using online data resourcing and re-assessed one month later.

RESULTS

At the first time point, during the beginning phases of the COVID-19 pandemic, AS was significantly related to COVID-19 distress and disability with a moderate effect size. AS was longitudinally associated with higher COVID-19 worry and depression.

LIMITATIONS

Our findings are limited by the use of a relatively small online sample. Additionally, assessment of pre-pandemic and post-pandemic symptoms and functioning would be beneficial for future research.

CONCLUSIONS

Taken together, the current study provided evidence consistent with AS as a causal risk factor for the development of distress and depression during the COVID-19 pandemic.

A Prospective Pilot Study of Anxiety Sensitivity and Adolescent Sports-Related Concussion

OBJECTIVE

This study examined the relationship of that anxiety sensitivity (AS) with the initial and ongoing symptoms reported by adolescents after sustaining a sports-related concussion (SRC).

METHOD

Participants were 40 adolescents, ages 13-18, presenting for treatment at a children's sports medicine specialty clinic following a diagnosis of either an SRC or a musculoskeletal injury. After the initial clinic intake, participants completed an online survey at three-time points. Survey measures included the self-report graded symptom checklist and the AS Index-3. Researchers used growth curve analysis to examine the relationship between AS Index-3 scores with initial and ongoing symptom reporting over time. The 20 participants sustaining an SRC were matched by age, gender, and race with 20 musculoskeletal injury controls.

RESULTS

Concussed adolescents with higher AS scores reported more initial symptoms than did those reporting musculoskeletal injury. AS was not related to the rate of symptom reduction over time for either group.

CONCLUSION

Higher AS moderated the relationship between injury type (concussion vs. musculoskeletal injury) and the total number of initial symptoms reported by adolescent participants, with every unit increase in AS yielding a four-unit increase in initial symptoms reporting. Previous research has shown that elevated initial symptom scores are a strong predictor of protracted recovery in concussion. AS is amenable to brief treatment interventions. It is a potential early target for treatment intervention following diagnosis of adolescent SRC.

Panic attack prediction using wearable devices and machine learning: Development and cohort study (Preprint)

Background

A panic attack (PA) is an intense form of anxiety accompanied by multiple somatic presentations, leading to frequent emergency department visits and impairing the quality of life. A prediction model for PAs could help clinicians and patients monitor, control, and carry out early intervention for recurrent PAs, enabling more personalized treatment for panic disorder (PD).

Objective

This study aims to provide a 7-day PA prediction model and determine the relationship between a future PA and various features, including physiological factors, anxiety and depressive factors, and the air quality index (AQI).

Methods

We enrolled 59 participants with PD (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and the Mini International Neuropsychiatric Interview). Participants used smartwatches (Garmin Vívosmart 4) and mobile apps to collect their sleep, heart rate (HR), activity level, anxiety, and depression scores (Beck Depression Inventory [BDI], Beck Anxiety Inventory [BAI], State-Trait Anxiety Inventory state anxiety [STAI-S], State-Trait Anxiety Inventory trait anxiety [STAI-T], and Panic Disorder Severity Scale Self-Report) in their real life for a duration of 1 year. We also included AQIs from open data. To analyze these data, our team used 6 machine learning methods: random forests, decision trees, linear discriminant analysis, adaptive boosting, extreme gradient boosting, and regularized greedy forests.

Results

For 7-day PA predictions, the random forest produced the best prediction rate. Overall, the accuracy of the test set was 67.4%-81.3% for different machine learning algorithms. The most critical variables in the model were questionnaire and physiological features, such as the BAI, BDI, STAI, MINI, average HR, resting HR, and deep sleep duration.

Conclusions

It is possible to predict PAs using a combination of data from questionnaires and physiological and environmental data.

Pilot randomized clinical trial targeting anxiety sensitivity: effects on physical activity

Anxiety sensitivity (AS)-the tendency to interpret anxiety as an aversive state-is associated with low rates of physical activity. Previous interventions targeting AS via exercise-based interoceptive exposure have not assessed physical activity as an outcome and are limited by brief follow-up periods. This study replicated and extended previous work by including a 6-week follow-up and assessing physical activity. Participants were 44 sedentary young adults with elevated AS randomized to intervention (six 20-minute sessions of moderate-intensity walking) or assessment-only control. Assessments of AS and physical activity were conducted at baseline and weeks 2 (post-treatment), 4, and 8. Between-group change in AS and physical activity over time was assessed using hierarchical linear modeling. The intervention condition demonstrated a marginally significant reduction in AS compared to control at week 4, which eroded by week 8. There were no significant between-group differences for change in physical activity. Findings indicate that a brief intervention might not be sufficient to produce lasting changes in AS or related exercise avoidance without additional treatment. Intervention effects were weaker than previous reports, which may be due to the greater racial/ethnic diversity of the current sample. Future research should objectively measure physical activity and explore individual variability in response.ClinicalTrials.gov identifier: NCT03128437.

Psychometric properties of the Anxiety Sensitivity Index-3 in adults with substance use disorders

Anxiety sensitivity, or the fear of anxiety-related sensations, has demonstrated relevance to a broad range of psychiatric conditions, including substance use disorders (SUDs). Anxiety sensitivity is typically measured through self-report instruments, most commonly the Anxiety Sensitivity Index-3 (ASI-3). Despite the widespread use of the ASI-3 in studies of SUDs, little is known about its psychometric properties within this population. Patients on an inpatient detoxification unit seeking treatment for SUDs (N = 1248) completed a battery of self-report measures, including the ASI-3. Psychometric properties of the ASI-3 were examined. An exploratory factor analysis with half of the sample (n = 624) supported a 3-factor structure corresponding to the ASI-3 subscales (Social Concerns, Cognitive Concerns, Physical Concerns). Confirmatory factor analysis was used to validate this 3-dimensional structure in a separate subsample (n = 624), resulting in adequate fit when testing a second-order hierarchical model. Internal consistency and convergent and discriminant validity results also supported the use of the ASI-3 in people with SUDs. Despite its widespread use in SUD research, this is the first psychometric investigation of the ASI-3 among individuals seeking treatment for SUDs.

Development and Initial Validation of the Relaxation Sensitivity Index

Relaxation sensitivity indexes the fear of relaxation-related events. The purpose of this study was to develop and provide initial validation of a self-report measure of relaxation sensitivity, the Relaxation Sensitivity Index (RSI). Three independent samples of undergraduate students (n=300 unselected, n=349 non-clinical, and n=197 clinical analogs with elevated anxiety/depression symptoms) completed self-report measures to examine the factor structure, reliability, and validity of the RSI. Results of exploratory and confirmatory factor analyses supported a three-factor structure (correlated Physical, Cognitive, and Social Concerns). The RSI demonstrated good internal consistency and construct validity as evidenced by expected correlations with measures of anxiety and depression symptoms. The RSI showed good predictive validity in terms of a history of fearful responding to relaxation. RSI scores were significantly higher in the symptomatic compared to non-clinical sample. Results suggest the RSI is a valid and reliable measure that may be useful in clinical and research settings.

Transdiagnostic Versus Construct-Specific Cognitive Behavioural Therapy for Emotional Disorders in Patients with High Anxiety Sensitivity: A Double-Blind Randomised Clinical Trial

Anxiety sensitivity (AS) is a common vulnerability in emotional disorders. Due to the pathological role of AS, individuals with high AS are faced with emotional problems. Thus, cognitive behavioural interventions try to reduce these problems by targeting AS. The present study aimed to compare the efficacy of transdiagnostic cognitive behavioural therapy (T-CBT) and construct-specific CBT (CS-CBT) on AS, anxiety, depression, and positive and negative affect in these patients. To this end, 40 patients with high AS were randomly assigned to one of the three groups of T-CBT, CS-CBT, and wait list. Participants were assessed using the Anxiety and Related Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory-II, and Positive and Negative Affect Schedule at baseline, post-treatment, 3-month follow-up, and 6-month follow-up. The findings showed that T-CBT and CS-CBT have a significant effect on AS, anxiety, and negative affect; however, contrary to T-CBT, CS-CBT is not effective for reducing depression and positive affect. T-CBT had a more promising efficacy than CS-CBT in all treatment outcomes. The results show better and more stable efficacy of T-CBT among patients with high AS. It is essential to consider AS as a target for cognitive behavioural intervention for the spectrum of emotional disorders.

Adventurous Play as a Mechanism for Reducing Risk for Childhood Anxiety: A Conceptual Model

In this conceptual article, we draw upon the literature regarding cognitive and behavioural factors that underpin childhood anxiety to outline how a range of these risk markers might be targeted through adventurous play. When children play in an adventurous way, climbing trees, riding their bikes fast downhill and jumping from rocks, they experience feelings of fear and excitement, thrill and adrenaline. We propose that the positive, thrilling and playful emotions associated with this type of child-led play facilitate exposure to fear-provoking situations and, in doing so, provide opportunities for children to learn about physiological arousal, uncertainty and coping. We hypothesise that these learning opportunities will, over time, reduce children's risk for elevated anxiety by increasing children's expectations and ability to cope with anxiety, decreasing intolerance of uncertainty and preventing catastrophic misinterpretations of physiological arousal. If our conceptual model is correct, then ensuring that children have the physical and psychological space required to play in an adventurous way may help to decrease their risk for elevated or clinical anxiety.

Effects of Mass Shootings on the Mental Health of Children and Adolescents

PURPOSE OF REVIEW

To examine mass shootings in youth including mass shooting trends, risk and protective factors for emotional sequelae, mental health, prevention of mass shootings, and the assessment and treatment of survivors.

RECENT FINDINGS

Many youth are exposed to gun violence, with a smaller subset exposed to mass shootings. While youth have varying responses to mass shootings, possibly due to risk and protective factors as well as level of exposure, the mental health outcomes are significant and include posttraumatic stress, suicide, depression, substance abuse, and anxiety. Efforts at developing effective prevention and treatment programs are still underway but generally take a tiered public health approach. Mass shootings have significant mental health outcomes for youth survivors, particularly those with direct exposure or risk factors. Continued efforts are needed to better understand the effects of mass shootings and how to prevent them from occurring as well as how to best address the needs of survivors.

Effects of tryptophan depletion on anxiety, a systematic review

Vulnerability markers for onset of anxiety disorders are scarce. In depression, patients at risk tend to respond with a negative mood to 'acute tryptophan depletion' (ATD), while healthy volunteers and current patients do not. The serotonergic system thus provides indications for vulnerability for depression. It is unknown whether ATD reveals vulnerability in anxiety too. This study systematically reviews the effects of ATD on anxiety and assesses whether challenging anxiety modifies the response. PubMed, Embase and PsychInfo were systematically searched up to April 2019 for studies in which (1) healthy volunteers or patients with a (remitted) anxiety disorder underwent ATD and (2) levels of anxiety were reported. In total, 21 studies were included. Studies conducted in healthy volunteers (n = 13), and patients with a remitted (n = 6) or current (panic, social or generalised) anxiety disorder (n = 4). Studies were mostly of poor quality and heterogeneous regarding population, challenge test used and outcome measures. ATD did not consistently affect anxiety in any of the groups. Moreover, a challenge test after ATD (n = 17 studies) did not consistently provoke anxiety in healthy volunteers or remitted patients. A 35% CO₂ challenge did consistently increase anxiety in patients with a current panic disorder (PD). To conclude, this systematic review found no clear indications that ATD provokes anxiety in those at risk for anxiety disorders. Hence, unlike in depression, ATD does not indicate vulnerability to develop an anxiety disorder. Because included studies were heterogeneous and mostly of poor quality, there is an urgent need for high quality research in homogeneous samples.

Relationship of affect intolerance with anxiety, depressive, and obsessive-compulsive symptoms in youth

BACKGROUND

Structural research on the construct of affect intolerance (an overarching latent construct indicated by distress tolerance and anxiety sensitivity) has only been conducted in adults. Given that a self-report measure of distress tolerance was recently validated for youth and affect intolerance may be a core mechanism of transdiagnostic interventions for internalizing disorders, we examined how affect intolerance relates to internalizing symptoms in youth. We predicted that a latent affect intolerance factor (indicated by distress tolerance and anxiety sensitivity) would be associated with self and parent-reports of youth anxiety, depressive, and obsessive-compulsive symptoms, controlling for age and gender.

METHODS

At a pre-treatment evaluation, youth with a primary depressive, anxiety, or obsessive-compulsive spectrum disorder (N=277) aged 8-17, and their parent, completed questionnaires.

RESULTS

Greater levels of the affect intolerance factor predicted greater youth- and parent-reported youth anxiety, depression, and obsessive-compulsive symptoms, controlling for age.

LIMITATIONS

Future research should replicate findings in a sample with a greater proportion of depressed youth and utilize experimental or longitudinal methods.

CONCLUSIONS

Importantly, distress tolerance and anxiety sensitivity are core transdiagnostic processes that can be targeted in cognitive-behavioral interventions. Future research should examine how transdiagnostic interventions for youth with internalizing disorders can target these cross-cutting emotional vulnerabilities.

COVID-19 and Anxiety Sensitivity Across Two Studies in Argentina: Associations with COVID-19 Worry, Symptom Severity, Anxiety, and Functional Impairment

Background

The novel 2019 SARS2-Coronavirus (COVID-19) has had a devastating physical health, mental health, and economic impact, causing millions of infections and hundreds of thousands of deaths. While COVID-19 has impacted the entire world, COVID-19 has disproportionately impacted low-income countries, particularly in South America, causing not only increased mortality but also increased associated mental health complaints. Anxiety sensitivity (AS), reflecting fear of anxiety-related physical sensations, may be particularly important to understand COVID-19 mental health effects among Latinx individuals in South America (Argentina). Past work suggests that Latinx individuals report greater somatization of mental health symptoms, and AS has been specifically linked to greater mental health symptoms. Yet, to date, no work has examined AS as a vulnerability factor for the negative mental health effects of COVID-19.

Method

Therefore, the current manuscript examined the association of AS with COVID-19 worry, functional impairment, anxiety, and symptom severity across two samples of adults in Argentina: a community sample (n = 105, M _age  = 38.58, SD = 14.07, 69.5% female) and a clinical sample comprised of individuals with an anxiety disorder (n = 99, M _age  = 34.99, SD = 10.83, 66.7% female).

Results

Results from the current study provide support for AS as a potential vulnerability factor for COVID-19-related mental health problems across both samples, and these effects were evident over and above the variance accounted for by age, sex, pre-existing medical conditions, and COVID-19 exposure.

Conclusions

These data identify AS as a potential intervention target to reduce COVID-19 mental health burden among adults in Argentina.

Separation Anxiety Disorder in Panic Disorder Patients with and without Comorbid Agoraphobia

Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which continues into adulthood, is associated with PD with and without comorbid agoraphobia in adult patients. Our primary hypothesis was that PD patients with comorbid agoraphobia had a higher rate of SAD that continues into adulthood than those without agoraphobia. We also hypothesized that adulthood SAD symptoms were more likely to be associated with PD-agoraphobia than PD without agoraphobia.Method: 151 patients who were diagnosed with PD with (n = 106), and without comorbid agoraphobia (n = 45) were compared using Panic and Agoraphobia Scale, Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, and State-Trait Anxiety Inventory. We performed Student's t-test, Pearson correlation test, and multiple linear regression analysis in this study.Results: PD patients with comorbid agoraphobia were more likely to have SAD both in childhood and adulthood (p = .028), than those without agoraphobia. There were mild to moderate significant correlations between PD severity and state anxiety (p = .002), trait anxiety (p = .006), and SAD in childhood (p = .049), and in adulthood (p = .001). SAD in adulthood (β = 0.278, Exp(B) = 0.136, p = .003), and state anxiety (β = 0.236, Exp(B) = 0.164, p = .012) significantly predicted the severity of PD in patients with comorbid agoraphobia.Conclusion: SAD that continues in adulthood may be related to the severity of PD in patients with agoraphobia. Our findings might provide some evidence of the role of SAD in adulthood in patients with adult-onset PD-agoraphobia.

A multidimensional investigation of anxiety sensitivity and depression outcomes in cognitive-behavioral group therapy

We examined how anxiety sensitivity - the fear of symptoms of anxiety due to their perceived harmful effects - and gender are associated with treatment trajectory and outcomes in a large outpatient sample (N = 278) who received 14-weeks of cognitive-behavioral group therapy (CBGT) for depression. Three dimensions of anxiety sensitivity (cognitive, physical, and social concerns) and depression were assessed at pre-treatment, and the latter was assessed weekly during treatment. Latent growth curve models supported a link between cognitive concerns (fears of losing control over thoughts) and greater improvement in depression near the end of treatment (i.e., weeks 10-14); gender did not moderate trajectory. Gender (i.e., identifying as a woman) and greater physical concerns (fears of physical consequences of arousal symptoms) were associated with completion of < 8 sessions. Results suggest that those with more cognitive concerns might require greater time in treatment and/or benefit most from the focus on maladaptive assumptions and core beliefs in later CBGT sessions. Future research, including investigation of intervening variables, may elucidate the mechanisms through which greater physical concerns and gender are associated with treatment non-completion. Results supported differential associations of anxiety sensitivity dimensions with depression treatment outcomes, though further research attention is needed.

Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory

The State-Trait Anxiety Inventory - Trait version (STAI-T) was developed to measure an individual's tendency to experience anxiety, but it may lack discriminant evidence of validity based on strong observed relationships with measures of depression. The present series of meta-analyses compares STAI-T scores among individuals with depressive disorders, anxiety disorders, and nonclinical comparison groups, as well as correlations with measures of anxiety and depressive symptom severity, in order to further examine discriminant and convergent validity. A total of 388 published studies (N = 31,021) were included in the analyses. Individuals with an anxiety disorder and those with a depressive disorder displayed significantly elevated scores on the STAI-T compared to nonclinical comparison groups. Furthermore, anxiety and depressive symptom severity were similarly strongly correlated with the STAI-T (mean r = .59 - .61). However, individuals with a depressive disorder had significantly higher STAI-T scores than individuals with an anxiety disorder (Hedges's g = 0.27). Given these findings, along with previous factor analyses that have observed a depression factor on the STAI-T, describing the scale as a measure of 'trait anxiety' may be a misnomer. It is proposed that the STAI-T be considered a non-specific measure of negative affectivity rather than trait anxiety per se.

Predictors of anxiety during the COVID-19 pandemic in Poland

A coronavirus pandemic hit the world and Poland was no exception. The present research sought to investigate different factors associated with coronavirus-related anxiety during the COVID-19 outbreak in Poland. More specifically, COVID-19-related risk perceptions, beliefs, precautionary actions, information sources, and anxiety level were studied on general population (N = 1069) in Poland between March 29th and April 17th 2020. Multiple regression was used to examine the significant predictions of anxiety. Data revealed that anxiety in response to the COVID-19 was common in the sample. Major predictors of higher anxiety related to the pandemic outbreak included demographic factors, like being female, being older, being married or cohabiting, and having children. Additionally, greater anxiety was reported among people who reported chronic illnesses and generally worse health condition. From COVID-19 related factors, higher frequency of recommended protective behaviors, greater perceived risk of infection, greater likelihood of contacting COVID-19 during the current outbreak, greater amounts of information about COVID-19 received from various sources, and very little or lack of belief that degree of catching COVID-19 depends on one's own behavior predicted greater anxiety among individuals.

Reciprocal links between anxiety sensitivity and obsessive-compulsive symptoms in youth: a longitudinal twin study

BACKGROUND

Anxiety sensitivity, the tendency to fear the symptoms of anxiety, is a key risk factor for the development anxiety disorders. Although obsessive-compulsive disorder was previously classified as an anxiety disorder, the prospective relationship between anxiety sensitivity and obsessive-compulsive symptoms (OCS) has been largely overlooked. Furthermore, a lack of genetically informative studies means the aetiology of the link between anxiety sensitivity and OCS remains unclear.

METHODS

Adolescent twins and siblings (N = 1,579) from the G1219 study completed self-report questionnaires two years apart assessing anxiety sensitivity, OCS, anxiety and depression. Linear regression models tested prospective associations between anxiety sensitivity and OCS, with and without adjustment for anxiety and depressive symptoms. A phenotypic cross-lagged model assessed bidirectional influences between anxiety sensitivity and OCS over time, and a genetic version of this model examined the aetiology of these associations.

RESULTS

Anxiety sensitivity was prospectively associated with changes in OCS, even after controlling for comorbid anxiety and depressive symptoms. The longitudinal relationship between anxiety sensitivity and OCS was bidirectional, and these associations were predominantly accounted for by nonshared environmental influences.

CONCLUSIONS

Our findings are consistent with the notion that anxiety sensitivity is a risk factor for OCS during adolescence, but also suggest that experiencing OCS confers risk for heightened anxiety sensitivity. The reciprocal links between OCS and anxiety sensitivity over time are likely to be largely mediated by nonshared environmental experiences, as opposed to common genes. Our findings raise the possibility that interventions aimed at ameliorating anxiety sensitivity could reduce risk for OCS, and vice versa.

Parental Emotion-Focused Behaviors Moderate the Relationship Between Perceptual Sensitivity and Fear Reactivity in Anxious Children

This investigation examined the synergistic role of parental emotion-focused socialization behaviors and children's perceptual sensitivity on children's fear reactivity. A sample of 105 children with anxiety disorders (8-12 years; M = 10.07 years, SD = 1.22; 57% female) and their clinically anxious mothers (M = 39.35 years, SD = 7.05) completed an assessment battery that included a diagnostic interview and questionnaires regarding anxiety symptoms, perceptual sensitivity, and emotion socialization behaviors; children also completed a 5-min, videotaped speech task, and rated their fear levels before and after the task. Analyses revealed a significant interaction between perceptual sensitivity and emotion-focused strategies predicting fear change scores from pre- to post-speech. Higher perceptual sensitivity was related to greater reductions in fear from pre- to post- speech (adjusting for pre-speech fear scores), yet only among anxious children whose mothers reported high use of emotion-focused strategies. Maternal emotion-focused socialization strategies may increase anxious children's ability to modulate their affective responses during stressful situations.

Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders

Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.

Parental Presence Impacts a Neural Correlate of Anxiety (the Late Positive Potential) in 5-7 Year Old Children: Interactions with Parental Sensitivity to Child Anxiety

Anxiety disorders tend to onset early in development and often result in chronic impairment across the lifespan. Thus, there is substantial interest in identifying early neural markers of anxiety and leveraging these markers to better understand processes leading to anxiety. The late positive potential (i.e., LPP) indexes sustained attention to motivationally relevant stimuli; and the LPP to negative images is increased in individuals with anxiety. In the current study, we examined how parental presence impacts the LPP to threatening images in children (52.6% male) between 5 and 7 years-old (N = 78). Moreover, we explored interactions with parental sensitivity to child anxiety symptoms. Results suggest that when children are in the presence of their parent (compared to the presence of an experimenter), they displayed a larger LPP to threatening images. LPP activity was modulated by parental response to their child's anxiety symptoms, such that children with parents who were overly reactive to their children's anxiety symptoms had the greatest LPP response when viewing threatening stimuli in their parent's presence. Additionally, exploratory analyses indicated that children with clinical and subclinical anxiety were characterized by an increased LPP to negative images, but only when the LPP was measured with parents in the room. Findings are novel and extend previous work by suggesting that parents who react strongly when observing their children's anxiety symptoms in turn increase their child's engagement with threatening stimuli, thereby placing them at greater risk for anxiety.

Generalization of Conditioned Contextual Anxiety and the Modulatory Effects of Anxiety Sensitivity

Anxiety patients overgeneralize fear responses, possibly because they cannot distinguish between cues never been associated with a threat (i.e., safe) and threat-associated cues. However, as contexts and not cues are discussed as the relevant triggers for prolonged anxiety responses characterizing many anxiety disorders, we speculated that it is rather overgeneralization of contextual anxiety, which constitutes a risk factor for anxiety disorders. To this end, we investigated generalization of conditioned contextual anxiety and explored modulatory effects of anxiety sensitivity, a risk factor for anxiety disorders. Fifty-five participants underwent context conditioning in a virtual reality paradigm. On Day 1 (acquisition), participants received unpredictable mildly painful electric stimuli (unconditioned stimulus, US) in one virtual office (anxiety context, CTX+), but never in a second office (safety context, CTX-). Successful acquisition of conditioned anxiety was indicated by aversive ratings and defensive physiological responses (i.e., SCR) to CTX+ vs CTX-. On Day 2 (generalization), participants re-visited both the anxiety and the safety contexts plus three generalization contexts (G-CTX), which were gradually dissimilar to CTX+ (from 75 to 25%). Generalization of conditioned anxiety was evident for ratings, but less clear for physiological responses. The observed dissociation between generalization of verbal and physiological responses suggests that these responses depend on two distinct context representations, likely elemental and contextual representations. Importantly, anxiety sensitivity was positively correlated with the generalization of reported contextual anxiety. Thus, this study demonstrates generalization gradients for conditioned contextual anxiety and that anxiety sensitivity facilitates such generalization processes suggesting the importance of generalization of contextual anxiety for the development of anxiety disorders.