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Probert-Lindström S, Perrin S. An examination of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in adults in routine psychiatric care. Acta Psychol (Amst) 2023; 235:103902. [PMID: 37004421 DOI: 10.1016/j.actpsy.2023.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
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.
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Garey L, Zvolensky MJ, Gallagher MW, Vujanovic A, Kendzor DE, Stephens L, Cheney MK, Cole AB, Kezbers K, Matoska CT, Robison J, Montgomery A, Zappi CV, Businelle MS. A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40713. [PMID: 36409958 PMCID: PMC9728024 DOI: 10.2196/40713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. OBJECTIVE This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. METHODS The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. RESULTS Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19-specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. CONCLUSIONS Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40713.
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Affiliation(s)
- Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Department of Behavioral Science, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Lancer Stephens
- College of Public Health, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
- Oklahoma Shared Clinical and Translational Research Resources, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Ashley B Cole
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Cameron T Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Christopher V Zappi
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
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Fairweather-Schmidt AK, Wade TD. Common genetic architecture and environmental risk factors underpin the anxiety-disordered eating relationship: Findings from an adolescent twin cohort. Int J Eat Disord 2020; 53:52-60. [PMID: 31429983 DOI: 10.1002/eat.23155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Despite established comorbidity between anxiety and disordered eating (DE), and a plethora of research using various methodologies to examine this overlap, use of twin modeling to expose whether a shared genetic liability underpins these conditions remains rare. METHOD Data from a longitudinal sample of female twins were selected: measures of risk for DE from Wave 1 (N = 699, 351 pairs, aged 12-15 years), and the Eating Disorder Examination (EDE) and Children's Anxiety Sensitivity Index (CASI) from Wave 2 (N = 669, 338 pairs, aged 16-19 years). At this time, they also completed Children's Anxiety Sensitivity Index (CASI). Bivariate Cholesky decomposition models adjusting for age and body mass index centile investigated the covariance structure between the CASI and EDE. RESULTS Modeling both genetic and nonshared environmental influences parsimoniously fit these data. All paths were significant. Additive genetic influences were notable for CASI and EDE phenotypes; 14% of the heritable variance was contributed by CASI to the expression of EDE. There was also a smaller but significant contribution of nonshared environmental influences. A multinomial logistic regression indicated body dissatisfaction (RRR = 1.53; 95% CI = 1.07-2.18) differentiated groups with highest EDE scores from the highest CASI scores. DISCUSSION Shared genetic and environmental influences appear to underpin the relationship, and potentially the observed comorbidity, between anxiety sensitivity and DE. The age of onset is typically earlier for anxiety than DE, suggesting a significant opportunity for early intervention work to reduce the likelihood of subsequent development of DE.
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Affiliation(s)
- A Kate Fairweather-Schmidt
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Discipline of Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Horenstein A, Potter CM, Heimberg RG. How does anxiety sensitivity increase risk of chronic medical conditions? CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arielle Horenstein
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
| | - Carrie M. Potter
- Department of Psychiatry of Cambridge Health Alliance; Harvard Medical School; Boston Massachusetts
| | - Richard G. Heimberg
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
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Nowakowski ME, Rowa K, Antony MM, McCabe R. Changes in Anxiety Sensitivity Following Group Cognitive-Behavior Therapy for Social Anxiety Disorder and Panic Disorder. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-015-9750-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lechner WV, Shadur JM, Banducci AN, Grant DM, Morse M, Lejuez CW. The mediating role of depression in the relationship between anxiety sensitivity and alcohol dependence. Addict Behav 2014; 39:1243-8. [PMID: 24813550 DOI: 10.1016/j.addbeh.2014.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/06/2014] [Accepted: 04/02/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many studies have reported that Anxiety Sensitivity (AS) is positively associated with alcohol use or other alcohol-related variables. More recent mediator and moderator models have shown promise in elucidating mechanisms within this relationship; the literature to date suggests that the relationship between AS and alcohol is likely mediated by problematic coping motives. However, few studies have considered the effects of depression within the AS-alcohol use relationship, despite a strong body of evidence linking AS to subsequent depression and depression to subsequent alcohol use problems, independently. Therefore, the current study assessed depression as a potential mediator of this relationship. METHOD Participants were 418 sequential admissions to a substance abuse treatment facility. A mediation analysis using bootstrapping was utilized in order to estimate indirect effects of AS on alcohol dependence through depression. RESULTS Results reveal an indirect effect suggesting that the effects of anxiety sensitivity on alcohol dependence are mediated by symptoms of depression. More specifically, the effects of AS total score and AS somatic sensations on alcohol dependence were mediated by symptoms of depression. Lastly, a dual mediator model demonstrated that both depression and problematic coping uniquely mediate the relationship between AS and alcohol dependence. CONCLUSIONS While preliminary in nature, the current study provides evidence supporting the hypothesis that depression is an important factor to consider when examining the relationship between AS and alcohol dependence.
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Affiliation(s)
- William V Lechner
- Oklahoma State University, 118 North Murray Hall, Stillwater, OK 74075, United States; Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States.
| | - Julia M Shadur
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States
| | - Anne N Banducci
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States
| | - DeMond M Grant
- Oklahoma State University, 118 North Murray Hall, Stillwater, OK 74075, United States
| | - Melanie Morse
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States
| | - C W Lejuez
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States
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Norr AM, Allan NP, Macatee RJ, Keough ME, Schmidt NB. The effects of an anxiety sensitivity intervention on anxiety, depression, and worry: mediation through affect tolerances. Behav Res Ther 2014; 59:12-9. [PMID: 24949907 PMCID: PMC4151115 DOI: 10.1016/j.brat.2014.05.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/24/2014] [Accepted: 05/28/2014] [Indexed: 11/29/2022]
Abstract
Recently there has been increased interest in emotional and physical tolerance risk factors for mood and anxiety disorders. Three tolerance risk factors that have been shown to be related are anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI). Although previous research has demonstrated these constructs are malleable, no research has investigated the effects of an AS intervention on DT or DI. Further, no studies have investigated whether changes in DT or DI play a role in mood and anxiety symptom amelioration due to an AS intervention. Participants (N = 104), who were selected for elevated levels of AS, completed a single-session computer-assisted AS intervention or a control intervention and follow-up assessments at 1-week and 1-month post intervention. Results revealed that the intervention reduced AS and increased DT, but did not affect DI at the 1-week follow-up. Mediation analyses revealed that changes in AS and DT both mediated changes in symptoms (depression, anxiety, worry) due to the intervention at 1-month follow-up, however, when AS and DT were considered in the same model only the effect via AS remained significant. These results have important implications for the nature of the relationships between AS, DT, and DI as well as the specific mechanistic pathways through which an AS intervention ameliorates symptoms.
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Affiliation(s)
- Aaron M Norr
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Nicholas P Allan
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Richard J Macatee
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Meghan E Keough
- University of Washington, Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, 325 Ninth Ave, PS-5035, Box 359911, Seattle, WA 98104, USA.
| | - Norman B Schmidt
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
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Direct and Interactive Effects of Distress Tolerance and Anxiety Sensitivity on Generalized Anxiety and Depression. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9623-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Maack DJ, Tull MT, Gratz KL. Examining the incremental contribution of behavioral inhibition to generalized anxiety disorder relative to other Axis I disorders and cognitive-emotional vulnerabilities. J Anxiety Disord 2012; 26:689-95. [PMID: 22750475 DOI: 10.1016/j.janxdis.2012.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/23/2012] [Accepted: 05/21/2012] [Indexed: 10/28/2022]
Abstract
The goal of the present study was to investigate the incremental contribution of behavioral inhibition system (BIS) sensitivity to the presence of a current generalized anxiety disorder (GAD) diagnosis relative to other Axis I disorders (e.g., major depression, other anxiety disorders) and cognitive-emotional vulnerabilities (e.g., anxiety sensitivity, emotion dysregulation) previously found to be associated with GAD. Participants were 91 individuals recruited from the local community who completed a diagnostic interview and self-report questionnaires. Consistent with expectations, BIS sensitivity emerged as a significant predictor of current GAD status above and beyond major depression, anxiety disorder diagnoses, anxiety sensitivity, emotion dysregulation, and behavioral activation system sensitivity. However, emotion dysregulation also emerged as a significant predictor of GAD status in the final model. Findings speak to the importance of considering BIS sensitivity in models of the development and maintenance of GAD.
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Affiliation(s)
- Danielle J Maack
- Department of Psychology, University of Mississippi, 205 Peabody Building, University, MS 38677, United States.
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Rosellini AJ, Fairholme CP, Brown TA. The temporal course of anxiety sensitivity in outpatients with anxiety and mood disorders: relationships with behavioral inhibition and depression. J Anxiety Disord 2011; 25:615-21. [PMID: 21377316 PMCID: PMC3074026 DOI: 10.1016/j.janxdis.2011.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 02/01/2011] [Accepted: 02/01/2011] [Indexed: 11/29/2022]
Abstract
The present study evaluated the temporal course of three dimensions of anxiety sensitivity (AS; concerns over physical symptoms, mental incapacitation, and social embarrassment) and their relationships with behavioral inhibition (BI) and depression (DEP) in 606 outpatients with anxiety and mood disorders. A semi-structured interview and self-report questionnaires were administered on three occasions over a two-year period. All three constructs decreased over the study period and AS temporally functioned more similar to DEP than BI. Cross-sectional and temporal correlations supported the discriminant validity of AS from BI. As expected, initial levels of BI predicted less improvement in all AS dimensions. In contrast, higher initial levels of mental incapacitation AS were associated with greater improvement in DEP. Our results are discussed in regard to the measurement of AS in clinical samples, conceptualizations of AS as a lower-order vulnerability, and prognostic implications of directional paths between BI and AS and AS and DEP.
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Anxiety Sensitivity and Disabling Chronic Health Conditions State of the Art and Future Directions. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/028457100300049719] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Anxiety sensitivity profile: predictive and incremental validity. J Anxiety Disord 2008; 22:1180-9. [PMID: 18242951 PMCID: PMC2600663 DOI: 10.1016/j.janxdis.2007.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 12/11/2007] [Accepted: 12/14/2007] [Indexed: 11/23/2022]
Abstract
Anxiety sensitivity (AS) is a well-researched risk factor for the development of anxiety psychopathology. AS is typically measured using the anxiety sensitivity index (ASI) but limitations have led to the creation of second generation measures of AS including the anxiety sensitivity profile (ASP). The ASP has not been used very extensively, however, and we believe this may be due to two important issues: (1) the ASP is lengthy, and (2) the predictive validity of the ASP is unexplored in relation to critical outcomes such as anxiety psychopathology. The purpose of the present report was to address these two issues. We evaluated whether an abbreviated form of the ASP was viable and also conducted tests of the scale's predictive validity. Findings suggest that a 22-item version of the ASP (i.e., ASP-22) is comparable to the original 60-item ASP. Moreover, the ASP-22 was predictive of anxious responding to a CO(2) challenge. In fact, the ASP-22 outperformed the ASI as a predictor of CO(2) reactivity. Also, the ASP-22 was a significant longitudinal predictor of incidence of Axis I diagnoses. In regard to predictive validity, the ASP-22 was comparable to the original ASP. In summary, the ASP-22 appears to represent a viable measure of AS that may complement the ASI.
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Asmundson GJG, Stapleton JA. Associations between dimensions of anxiety sensitivity and PTSD symptom clusters in active-duty police officers. Cogn Behav Ther 2008; 37:66-75. [PMID: 18470738 DOI: 10.1080/16506070801969005] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Prior studies have shown that anxiety sensitivity (AS) plays an important role in posttraumatic stress disorder (PTSD) symptom severity. The purpose of this study was to evaluate associations between empirically supported PTSD symptom clusters (i.e. reexperiencing, avoidance, numbing, hyperarousal) and AS dimensions (i.e. psychological concerns, social concerns, somatic concerns). Participants were 138 active-duty police officers (70.7% female; mean age = 38.9 years; mean time policing = 173.8 months) who, as a part of a larger study, completed measures of trauma exposure, PTSD symptoms, AS, and depressive symptoms. All participants reported experiencing at least one event that they perceived as traumatic, and 44 (31.9%) screened positive for PTSD. Officers with probable PTSD scored significantly higher on AS total as well as the somatic and psychological concerns dimensional scores than did those without PTSD. As well, a higher percentage of officers with probable PTSD scored positively on the AS-derived Brief Screen for Panic Disorder (Apfeldorf et al., 1994) compared with those without PTSD. A series of regression analyses revealed that depressive symptoms, number of reported traumas, and AS somatic concerns were significant predictors of PTSD total symptom severity as well as severity of reexperiencing. Avoidance was predicted by depressive symptoms and AS somatic concerns. Only depressive symptoms were significantly predictive of numbing and hyperarousal cluster scores. These findings contribute to understanding the nature of association between AS and PTSD symptom clusters. Implications for the treatment of individuals having PTSD with and without panic-related symptomatology are discussed.
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Affiliation(s)
- Gordon J G Asmundson
- Anxiety and Illness Behaviours Laboratory and The Traumatic Stress Group, University of Regina, Regina, Saskatchewan, Canada.
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Tull MT, Gratz KL. Further examination of the relationship between anxiety sensitivity and depression: the mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. J Anxiety Disord 2008; 22:199-210. [PMID: 17419002 DOI: 10.1016/j.janxdis.2007.03.005] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 03/09/2007] [Accepted: 03/10/2007] [Indexed: 11/23/2022]
Abstract
This study examined the role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed in the relationship between anxiety sensitivity (AS) and depressive symptom severity. A sample of 391 undergraduate students completed a series of questionnaires assessing the constructs of interest. Results provided support for a model where experiential avoidance and difficulties engaging in goal-directed behavior mediate the relationship between the AS dimensions of fear of cognitive dyscontrol and fear of publicly observable anxiety reactions and depressive symptom severity. The ability of this model to distinguish participants (N=53) reporting clinical levels of depression from those without (N=53) was then examined. The model was found to reliably distinguish between participants with and without clinical levels of depression. However, only experiential avoidance was a significant mediator. Implications for research on the role of AS in depression vulnerability and treatment are discussed.
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Affiliation(s)
- Matthew T Tull
- Center for Addictions, Personality, and Emotion Research, University of Maryland, USA.
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Zvolensky MJ, Kotov R, Bonn-Miller MO, Schmidt NB, Antipova AV. Anxiety sensitivity as a moderator of association between smoking status and panic-related processes in a representative sample of adults. J Psychiatr Res 2008; 42:69-77. [PMID: 17098257 PMCID: PMC2219200 DOI: 10.1016/j.jpsychires.2006.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 09/25/2006] [Accepted: 09/29/2006] [Indexed: 11/23/2022]
Abstract
The present investigation evaluated a moderational role of anxiety sensitivity (fear of anxiety and anxiety-related states; [McNally RJ. Anxiety sensitivity and panic disorder. Biological Psychiatry 2002; 52:938-946.]) in the relation between smoking status and anxiety/depressive symptoms in a Russian epidemiological sample (n = 390; 197 females, Mean age = 43.55). Consistent with prediction, anxiety sensitivity moderated the association of smoking status with indices of anxiety and depressive symptoms; the effects were evident after controlling for the variance accounted for by alcohol use problems, environmental stress (past month), and gender. These findings are discussed with regard to the role of anxiety sensitivity in etiologic connection between smoking and panic-related processes.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, The University of Vermont, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA.
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Stein MB, Schork NJ, Gelernter J. Gene-by-environment (serotonin transporter and childhood maltreatment) interaction for anxiety sensitivity, an intermediate phenotype for anxiety disorders. Neuropsychopharmacology 2008; 33:312-9. [PMID: 17460615 DOI: 10.1038/sj.npp.1301422] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anxiety sensitivity (AS) is a dispositional characteristic that predisposes to the development of anxiety disorders (eg, panic and post-traumatic stress disorder) and major depression. AS is subject to genetic and environmental influences, the former as yet unidentified and the latter known to include childhood maltreatment. The serotonin transporter gene (SLC6A4) promoter polymorphism (5-HTTLPR) has been associated with depression, but most consistently in the context of environmental stress. We tested the hypothesis that 5-HTTLPR genotype and childhood maltreatment would interact to increase susceptibility to AS in young adults. Subjects were European-American college undergraduates (N=150, median age 18 years) characterized on a measures of AS (Anxiety Sensitivity Index) and retrospective childhood maltreatment (Childhood Trauma Questionnaire [CTQ]). 5-HTTLPR genotypes were obtained from blood-derived DNA. Linear regression was used to model relationships between 5-HTTLPR, childhood emotional abuse, and AS; covariates such as sex, neuroticism, and ancestral proportion scores were incorporated into some models in a larger, ethnically heterogenous sample (N=247) to evaluate robustness of the findings to model assumptions. A statistically signficant interaction was observed between levels of childhood emotional (or physical) maltreatment and 5-HTTLPR genotype. Specifically, S/S individuals with higher levels of maltreatment had significantly higher levels of AS than subjects in other groups. No such relationship was found for neuroticism, attesting to the possible specificity of the findings for AS. Findings were consistently robust to the inclusion of covariates, and were not confounded by population stratification. In conclusion, these results provide evidence of a specific genetic influence on anxiety sensitivity-an intermediate phenotype for anxiety (and depressive) disorders; this effect is modified by severity of childhood maltreatment. These findings are consistent with the notion that 5-HTTLPR operates broadly to moderate emotional responsivity to stress.
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Affiliation(s)
- Murray B Stein
- Anxiety and Traumatic Stress Disorders Program, Departments of Psychiatry and Family & Preventive Medicine, University of California San Diego, La Jolla, CA 92093-0855, USA.
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Rector NA, Szacun-Shimizu K, Leybman M. Anxiety sensitivity within the anxiety disorders: Disorder-specific sensitivities and depression comorbidity. Behav Res Ther 2007; 45:1967-75. [PMID: 17084380 DOI: 10.1016/j.brat.2006.09.017] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 03/31/2006] [Accepted: 09/26/2006] [Indexed: 10/23/2022]
Abstract
The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.
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Affiliation(s)
- Neil A Rector
- Centre for Addiction and Mental Health, Canada, Mood and Anxiety Program, University of Toronto, Clarke Site, Toronto, ONT, Canada.
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Starcevic V, Berle D. Cognitive specificity of anxiety disorders: a review of selected key constructs. Depress Anxiety 2006; 23:51-61. [PMID: 16402368 DOI: 10.1002/da.20145] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cognitive models of anxiety disorders propose that certain cognitive constructs, that is, underlying beliefs and cognitive processes, may be specific for particular disorders. In this article, we review the specificity of four representative cognitive constructs-anxiety sensitivity, pathological worry, intolerance of uncertainty, and thought-action fusion-for particular disorders. Conceptual overlap, inconsistent definitions, and insufficient consideration of the components of these constructs are limitations of the existing literature. We suggest that the constructs are unlikely to be pathognomonic for any given disorder or to occur in isolation. Rather, the association of each cognitive construct is evident, to varying degrees, with different disorders. Relative to other disorders, anxiety sensitivity is to a certain extent specific for panic disorder, as are pathological worry for generalized anxiety disorder, intolerance of uncertainty for generalized anxiety disorder and obsessive-compulsive disorder, and thought-action fusion for obsessive-compulsive disorder. We discuss the implications of these findings for diagnostic systems and treatment, and suggest areas for further research.
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Affiliation(s)
- Vladan Starcevic
- University of Sydney and Nepean Hospital, Penrith, New South Wales, Australia.
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Tull MT, Gratz KL, Lacroce DM. The Role of Anxiety Sensitivity and Lack of Emotional Approach Coping in Depressive Symptom Severity Among a Non‐Clinical Sample of Uncued Panickers. Cogn Behav Ther 2006; 35:74-87. [PMID: 16754263 DOI: 10.1080/16506070500466733] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Panic attacks and depression frequently co-occur, and the presence of this co-morbidity is often associated with worse outcomes compared with each disorder alone. Despite this, not everyone who experiences panic attacks also suffers from depression, suggesting that individual difference factors may play a role in this co-morbidity. The purpose of this study was to provide a preliminary investigation of two such individual difference factors, examining the role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non-clinical sample of uncued panickers. A sample of 79 college students reporting the occurrence of uncued panic attacks within the past year completed a series of questionnaires assessing the lower-order factors of anxiety sensitivity, emotional approach coping, panic attack frequency, panic-related disability, panic symptom severity and depressive symptom severity. Participants with more severe depressive symptoms reported greater anxiety sensitivity, panic attack frequency, panic symptom severity, panic-related disability and lack of emotional approach coping. The particular anxiety sensitivity dimension of fear of cognitive dyscontrol and lack of emotional approach coping emerged as the best predictors of depressive symptom severity. Findings are discussed in terms of their implications for the improved understanding of this co-morbidity, as well as its treatment.
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Affiliation(s)
- Matthew T Tull
- Department of Psychology, University of Maryland, College Park, Maryland 20742, USA.
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Keenan K, Hipwell AE. Preadolescent clues to understanding depression in girls. Clin Child Fam Psychol Rev 2005. [PMID: 15984082 DOI: 10.1007/s10567.005.4750.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Between the ages of 10 and 15, increases in depression among girls result in a rate that is twice as high as the rate of depression in boys. This sex difference remains throughout early and middle adulthood. Prior to early adolescence, there is essentially no sex difference in the rate of depression. The aim of the present review is to examine whether the preadolescent period is a time during which precursors to depression in girls can be identified. First, existing areas of research on explaining sex differences in depression, including cognitive and affiliative style and the socialization of emotion, are reviewed. Second, the hypothesis that for some girls, preadolescent precursors to depression take the form of excessive empathy, compliance and regulation of negative emotions is articulated. Third, ways of building on existing models by including the proposed preadolescent precursors are proposed. Finally, approaches to testing the hypotheses that individual differences in these domains during preadolescence may explain later individual differences in adolescent onset depression are explored.
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Affiliation(s)
- Kate Keenan
- Department of Psychiatry, University of Chicago, Illinois 60637, USA.
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Abstract
Between the ages of 10 and 15, increases in depression among girls result in a rate that is twice as high as the rate of depression in boys. This sex difference remains throughout early and middle adulthood. Prior to early adolescence, there is essentially no sex difference in the rate of depression. The aim of the present review is to examine whether the preadolescent period is a time during which precursors to depression in girls can be identified. First, existing areas of research on explaining sex differences in depression, including cognitive and affiliative style and the socialization of emotion, are reviewed. Second, the hypothesis that for some girls, preadolescent precursors to depression take the form of excessive empathy, compliance and regulation of negative emotions is articulated. Third, ways of building on existing models by including the proposed preadolescent precursors are proposed. Finally, approaches to testing the hypotheses that individual differences in these domains during preadolescence may explain later individual differences in adolescent onset depression are explored.
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Affiliation(s)
- Kate Keenan
- Department of Psychiatry, University of Chicago, Illinois 60637, USA.
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Koven NS, Heller W, Miller GA. The unique relationship between fear of cognitive dyscontrol and self-reports of problematic drinking. Addict Behav 2005; 30:489-99. [PMID: 15718066 DOI: 10.1016/j.addbeh.2004.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Research has established positive associations between anxiety sensitivity (AS) and problematic drinking in clinical samples. The present study confirmed this relationship in a nonclinical sample (N=162) and investigated which AS dimension best predicts self-reports of problematic drinking. Only one AS facet, fear of cognitive dyscontrol (FCC), was associated with symptoms of alcohol dependence, severity of drinking problems, and alcohol-related expectations of global, positive changes, sexual enhancement, and tension reduction. The possible role of depression in these relationships was also evaluated. A series of hierarchical regressions revealed that, when trait anxiety, anxious arousal, and anxious apprehension were statistically removed, depression did not contribute significant variance beyond the effects of FMC and other anxiety measures. Results suggest that FCC is uniquely associated with self-reports of problematic drinking behaviors and attitudes. Implications for tension-reduction models of alcohol are discussed.
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Affiliation(s)
- Nancy S Koven
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel Street, Champaign, IL 61820, USA
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Smári J, Erlendsdóttir G, Björgvinsdóttir A, Ágústsdóttir VR. ANXIETY SENSITIVITY AND TRAIT-SYMPTOM MEASURES OF ANXIETY AND DEPRESSION. ANXIETY STRESS AND COPING 2003. [DOI: 10.1080/1061580031000107791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lang AJ, Kennedy CM, Stein MB. Anxiety sensitivity and PTSD among female victims of intimate partner violence. Depress Anxiety 2002; 16:77-83. [PMID: 12219339 DOI: 10.1002/da.10062] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to evaluate the relationship between anxiety sensitivity (AS) and posttraumatic stress disorder (PTSD) in women. The study involved three groups: women with no history of exposure to serious trauma (n = 30), women who had been exposed to intimate partner violence (IPV) but never developed PTSD (n = 23), and women with IPV exposure and current PTSD (n = 19). As a part of a larger study, they completed measures of AS, PTSD symptomatology, and depression. Women with PTSD reported the highest levels of AS, although traumatized women with PTSD reported more AS than did women with no trauma history. AS-related psychological concerns were a statistical predictor of PTSD symptoms when the entire sample of women was considered but not among the subset with a trauma history. Nonetheless, AS may be an important factor to consider in treatment of individuals with PTSD.
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Affiliation(s)
- Ariel J Lang
- San Diego VA Healthcare System, San Diego, California, USA.
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