Psychopathological correlates of anxiety sensitivity: evidence from clinical interviews and self-report measures

Anxiety sensitivity and social support in veterans with emotional disorders

OBJECTIVE

An understanding of the incremental value of social support in predicting psychopathology above transdiagnostic risk factors could speak to the benefit of leveraging social factors into existing, evidence-based interventions in veterans with emotional disorders. This cross-sectional study aimed to expand our understanding of associations between domains of anxiety sensitivity and facets of psychopathology in veterans with emotional disorders. We also determined whether social support predicted psychopathology above anxiety sensitivity domains and combat exposure and explored these relationships with a path model.

METHODS

One hundred and fifty-six treatment-seeking veterans with emotional disorders completed diagnostic interviews and assessments of demographics, social support, symptom measures (e.g., PTSD, depression, anxiety, and stress), and transdiagnostic risk factors (i.e., anxiety sensitivity). After data screening, 150 were included in regressions.

RESULTS

Using regression analyses with cross-sectional data, cognitive anxiety sensitivity concerns predicted PTSD and depression above combat exposure. Cognitive and physical concerns predicted anxiety, and cognitive and social concerns predicted stress. Above combat exposure and anxiety sensitivity, social support predicted PTSD and depression.

CONCLUSION

Focusing on social support in tandem with transdiagnostic mechanisms in clinical samples is critical. These findings inform transdiagnostic interventions and recommendations related to incorporation of assessment of transdiagnostic factors in clinical contexts.

The Spanish version of the esophageal hypervigilance and anxiety score shows strong psychometric properties: Results of a large prospective multicenter study in Spain and Latin America

BACKGROUND

Anxiety is a significant modulator of sensitivity along the GI tract. The recently described Esophageal Hypervigilance and Anxiety Score (EHAS) evaluates esophageal-specific anxiety. The aims of this study were as follows: 1. translate and validate an international Spanish version of EHAS. 2. Evaluate its psychometric properties in a large Hispano-American sample of symptomatic individuals.

METHODS

A Spanish EHAS version was developed by a Delphi process and reverse translation. Patients referred for high-resolution manometry (HRM) were recruited prospectively from seven Spanish and Latin American centers. Several scores were used: EHAS, Hospital Anxiety and Depression Scale (HADS), Eckardt score (ES), Gastroesophageal Reflux Questionnaire (GERDQ), and the Brief Esophageal Dysphagia Questionnaire (BEDQ). Standardized psychometric analyses were performed.

KEY RESULTS

A total of 443 patients were recruited. Spanish EHAS showed excellent reliability (Cronbach´s alpha = 0.94). Factor analysis confirmed the presence of two factors, corresponding to the visceral anxiety and hypervigilance subscales. Sufficient convergent validity was shown by moderate significant correlations between EHAS and other symptomatic scores. Patients with high EHAS scores had significantly more dysphagia. There was no difference in EHAS scores when compared normal vs abnormal or major manometric diagnosis.

CONCLUSIONS AND INFERENCES

A widely usable Spanish EHAS version has been validated. We confirm its excellent psychometric properties in our patients, confirming the appropriateness of its use in different populations. Our findings support the appropriateness of evaluating esophageal anxiety across the whole manometric diagnosis spectrum.

The Role of Anxiety Sensitivity and Expectancy Manipulation on Panic-Like Response to the 35% CO2 Challenge in Healthy Subjects

BACKGROUND

The 35% CO2 challenge is a well-established method triggering panic attacks under laboratory-controlled conditions. There is an ongoing debate whether single or the joined effects of the instructional set and anxiety sensitivity (AS) can alter the outcome of the challenge.

OBJECTIVES

The present study investigated the effects of instruction manipulation and AS on panic-like response to the 35% CO2 challenge.

METHODS

Eighty healthy subjects, with high or low levels of AS, were randomized into 4 groups based on standard/manipulated instructional sets as well as 35% CO2 mixture/room air inhalation. Subjects filled in the Visual Analogue Scale of Anxiety (VAAS), the Visual Analogue Scale of Fear (VAS-F), the VAS of Discomfort (VAS-D), and the Panic Symptom List (PSL). Blood pressure and heart rate were measured at pre- and posttest.

RESULTS

Hierarchical multiple regression analyses showed greater psychological responses at VAAS, VAS-F, VAS-D, and PSL and higher systolic blood pressure under 35% CO2 challenge if compared to room air inhalation while instructional set and AS did not influence the response.

CONCLUSIONS

The present study confirms that neither instructional test nor AS alter the outcome of the 35% CO2 challenge.

Incidence of panic disorder in patients with non-cardiac chest pain and panic attacks

This study documented the 6-month incidence of panic disorder and its predictors in emergency department patients with panic attacks and non-cardiac chest pain. The assessment included a validated structured interview to identify panic attacks and questionnaires measuring the potential predictors of panic disorder. Presence of panic disorder was assessed 6 months later. The incidence of panic disorder was 10.1 percent ( n = 14/138). Anxiety sensitivity was the only significant predictor of the incidence of panic disorder (odds ratio = 1.06; 95% confidence interval = 1.01–1.12). Patients with panic attacks and non-cardiac chest pain are at an elevated risk for panic disorder. This vulnerability appears to increase with anxiety sensitivity.

Death Anxiety Resilience; a Mixed Methods Investigation

Research was conducted examining how death anxiety influenced PTSD and mental health among people who have experienced a life-threatening event. This study was conducted using undergraduate university students in Lithuania. The study used a mixed-method design and in phase 1, participants (N = 97) completed self-report questionnaires that gathered information on demographics, death anxiety, trauma and well-being. Data indicated a significant correlation between death anxiety and PTSD, but not psychiatric co-morbidity. Phase 2 attempted to further explore the phenomenological experience of participants with full PTSD, and 6 semi-structured interviews were conducted. IPA analysis found three major themes in response to the life-threatening event; self-efficacy, religious coping and existential attitude. Overall these coping mechanisms allowed participants to develop resilience against the effects of death anxiety and minimize its negative impact on mental health.

Anxiety sensitivity as a predictor of broad dimensions of psychopathology after cognitive behavioral therapy for panic disorder

BACKGROUND

Panic disorder (PD) is a common disease and presents with broad dimensions of psychopathology. Cognitive behavioral therapy (CBT) is known to improve these broad dimensions of psychopathology in addition to PD symptoms. However, little is known about the predictors of treatment response in comorbid psychiatric symptoms after CBT for PD. Recent studies suggest that anxiety sensitivity (AS) may be a key vulnerability for PD. This study aimed to examine AS as a predictor of broad dimensions of psychopathology after CBT for PD.

MATERIALS AND METHODS

In total, 118 patients with PD were treated with manualized group CBT. We used multiple regression analysis to examine the associations between 3 Anxiety Sensitivity Index (ASI) factors (physical concerns, mental incapacitation concerns, and social concerns) at baseline and the subscales of the Symptom Checklist-90 Revised (SCL-90-R) at endpoint.

RESULTS

Low levels of social concerns at baseline predicted low levels on 5 SCL-90-R subscales after CBT: interpersonal sensitivity, depression, hostility, paranoid ideation, and psychosis. High levels of mental incapacitation concerns significantly predicted low levels on 3 SCL-90-R subscales after treatment: interpersonal sensitivity, hostility, and paranoid ideation. Physical concerns at baseline did not predict broad dimensions of psychopathology.

CONCLUSION

This study suggested that the social concerns and mental incapacitation concerns subscales of the ASI at baseline predicted several dimensions of psychopathology after CBT for PD. To improve comorbid psychopathology, it may be useful to direct more attention to these ASI subscales.

Anxiety Sensitivity or Interoceptive Sensitivity

Abstract. The construct of anxiety sensitivity (AS) – the fear of anxiety-related symptoms – has been highly influential in current conceptualizations of anxiety disorders in general, and panic disorder specifically. However, given documented associations between AS and both non-anxiety psychological disorders as well as medical/health conditions, the extent to which measures of AS are assessing a specific fear or anxiety symptoms versus a broader fear of interoceptive or bodily sensations is unclear. Confirmatory factor analysis of data from 373 participants failed to suggest whether fears of anxiety-related symptoms were factorially distinct from fears of non-anxiety-related bodily sensations, although analyses indicated that while fears of anxiety-related symptoms were more closely associated with panic disorder severity than were fears of non-anxiety-related symptoms, both were similarly and strongly associated with hypochondriacal fears. Implications for the construct of AS, and the broader construct of somatic fears, are discussed.

Relationships among depression, anxiety, anxiety sensitivity, and perceived social support in adolescents with conversion disorder

OBJECTIVE

This study aimed to assess the relationships of depression, anxiety, anxiety sensitivity, and perceived social support with conversion symptoms in adolescents with conversion disorder (CD).

METHODS

Fifty outpatients, aged 8-18 years, who had been diagnosed with CD and members of a control group were assessed using the psychological questionnaires.

RESULTS

Compared with controls, adolescents with CD scored higher on the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI) total, CASI physical and cognitive subscales, and Multidimensional Scale of Perceived Social Support family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the Somatoform Dissociation Questionnaire (SDQ) scores and that CDI and CASI total scores predicted the Children's Somatization Inventory (CSI) scores of subjects.

CONCLUSIONS

This study suggest that adolescents with CD had poor psychosocial well-being, and depression, global anxiety sensitivity and anxiety sensitivity cognitive concerns are related to conversion symptoms.

Anxiety Sensitivity and Panic Symptomatology: The Mediator Role of Hypochondriacal Concerns

The present study tests the mediating role of hypochondriasis to explain the relation between anxiety sensitivity and panic symptomatology. Fifty-seven outpatients with clinically significant levels of panic symptomatology were selected to participate in the study. Measures of anxiety sensitivity, hypochondriasis, and panic symptomatology were obtained from standardized, self-administered questionnaires: the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), the Whiteley Index of Hypochondriasis (WI; Pilowsky, 1967), and the Panic-Agoraphobic Spectrum Self-Report (PAS-SR; Cassano et al., 1997; Shear et al., 2001). Regression analyses were performed to test for the mediation models. The results show that the effect of anxiety sensitivity on panic symptomatology is not significant when controlling the hypochondriacal concerns, whereas the latter predicted panic symptoms. This result holds for the overall ASI as well as for the Physical Concerns and the Mental Incapacitation Concerns dimensions of the ASI scale. No evidence of a direct relation between the Social Concerns dimension and panic symptoms was found. The findings suggest that hypochondriacal concerns might represent the mechanism through which anxiety sensitivity is able to influence panic symptoms.

Examining the incremental contribution of behavioral inhibition to generalized anxiety disorder relative to other Axis I disorders and cognitive-emotional vulnerabilities

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.

Anxiety as a context for understanding associations between hypochondriasis, obsessive-compulsive, and panic attack symptoms

In the context of the integrative model of anxiety and depression, we examined whether the essential problem of hypochondriasis is one of anxiety. When analyzed, data from a large nonclinical sample corresponded to the integrative model's characterization of anxiety as composed of both broad, shared and specific, unique symptom factors. The unique hypochondriasis, obsessive-compulsive, and panic attack symptom factors all had correlational patterns expected of anxiety with the shared, broad factors of negative emotionality and positive emotionality. A confirmatory factor analysis showed a higher-order, bifactor model was the best fit to our data; the shared and the unique hypochondriasis and anxiety symptom factors both contributed substantial variance. This study provides refinements to an empirically based taxonomy and clarifies what hypochondriasis is and, importantly, what it is not.

Anxiety sensitivity and catastrophizing: associations with pain and somatization in non-clinical children

This study examined the relationships among anxiety sensitivity (AS), catastrophizing, somatization and pain in 240 non-clinical children (121 girls; mean age = 12.7 years). Children with pain problems (n = 81; 33.8%) reported greater AS and catastrophizing (ps < .01) relative to children without pain problems. AS but not catastrophizing was significantly associated with current pain. However, both AS and catastrophizing were significantly associated with somatization. AS and catastrophizing represent related but partially distinct cognitive constructs that may be targeted by interventions aimed at alleviating pain and somatization in children.

Die Bedeutung von Ekel- und Angstsensitivität bei Personen mit der Verdachtsdiagnose einer Hypochondrie

Zentrales Merkmal bei der hypochondrischen Störung ist die Befürchtung, an einer schweren Erkrankung zu leiden. Dies führt zur Fehlinterpretation normaler Körperfunktionen. Neben dysfunktionalen Angstzuständen ist auch stark ausgeprägte Angstsensitivität störungsrelevant. Das aktuelle Hypochondriekonzept ist vorwiegend angstfokussiert, während die Bedeutung anderer Emotionen wie zum Beispiel von Ekel bisher kaum untersucht wurde. Ziel dieser Untersuchung war es herauszufinden, ob die habituelle Ekelneigung einen zusätzlichen Prädiktor für die Vorhersage von Hypochondrie darstellt. Nach einem Screening mit einem standardisierten klinischen Interview wurden 27 Personen mit und 27 Personen ohne Verdachtsdiagnose Hypochondrie in die Studie eingeschlossen und getestet. Mittels Diskriminanzanalyse wurde überprüft, ob Ekelempfindlichkeit (Neigung einer Person, mit Ekel zu reagieren) und Ekelsensitivität (Neigung, Ekelempfindungen als bedrohlich zu bewerten) für die Gruppentrennung in Personen mit und ohne Verdachtsdiagnose Hypochondrie (Kriterium: Whitely Index) relevant sind. Es zeigte sich, dass habituelle Angst, Ekelsensitivität und spezifische Bereiche der Ekelempfindlichkeit (z. B. Abneigung vor mangelhafter Hygiene) zwischen den beiden Gruppen differenzierten. Domänenspezifische Beziehungen zwischen Ekelempfindlichkeit und Hypochondrie werden diskutiert.

An examination of recent non-clinical panic attacks, panic disorder, anxiety sensitivity, and emotion regulation difficulties in the prediction of generalized anxiety disorder in an analogue sample

Both non-clinical panic attacks and panic disorder (PD) have been found to be associated with generalized anxiety disorder (GAD). This study examined a proxy risk factor model of the relationship between non-clinical panic attacks, PD, and GAD. Specifically, it was proposed that non-clinical panic attacks and PD predict GAD only due to their shared association with anxiety sensitivity (AS) and difficulties in emotion regulation. Results demonstrated that emotion regulation difficulties reliably predicted GAD above and beyond the experience of non-clinical panic attacks and PD. However, although PD lost strength as a predictor, it remained significantly associated with GAD in the full model, providing only partial support for the proposed proxy risk factor model. Findings speak to the underlying role of emotion regulation difficulties in GAD, and suggest that it may be the shared relationship of these difficulties with both PD and GAD that partially explain the association of these disorders.

Anxiety sensitivity as a predictor of the clinical course of panic disorder: a 1-year follow-up study

BACKGROUND

There is evidence that negative affect (NA) and anxiety sensitivity (AS) predict the development of anxiety disorders, particularly panic disorder (PD). The main purpose of this study was to examine whether NA and AS will also predict the clinical course of PD.

METHODS

Participants were 136 individuals with a DSM-III-R diagnosis of PD (with or without agoraphobia) enrolled in a naturalistic and longitudinal study of anxiety disorders, the Harvard/Brown Anxiety Research Project (HARP). Participants were administered the Anxiety Sensitivity Index and the Negative Affect Scales of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X-NA) and their percentage of time in PD episode was followed for 1 year after the administration of the measures.

RESULTS

Multiple regression analyses indicated that AS, but not NA, was a significant predictor of percentage of time in PD episode after controlling for previous time in PD episodes, comorbid depression, other anxiety disorders, and exposure to psychopharmacological and behavioral treatments. As expected, the Physical Concerns subscale of the Anxiety Sensitivity Index had a significant independent contribution in predicting the course of the disorder.

CONCLUSIONS

Overall, these findings suggest that AS, as a unique construct, may be predictive of the amount of time patients are in episode of PD.

Is anxiety sensitivity a predictor of PTSD in children and adolescents?

OBJECTIVE

Anxiety sensitivity (AS) is the fear of the physical symptoms of anxiety and related symptoms. Longitudinal studies support AS as a vulnerability factor for development of anxiety disorders. This study aimed to investigate AS as a vulnerability factor in the development of childhood posttraumatic stress disorder (PTSD) following traumatic experiences.

METHODS

The study included 81 children 8-15 years of age who experienced the 1999 earthquake in Bolu, Turkey. The earthquake survivors were compared to a randomized group of age- and sex-matched controls 5 years after the earthquake. Both the subject and control groups were administered the Childhood Anxiety Sensitivity Index (CASI), State and Trait Anxiety Inventory for Children (STAI-C), and Child Depression Inventory (CDI), while the PTSD symptoms of the subjects were assessed using the Child Posttraumatic Stress Reaction Index (CPTS-RI).

RESULTS

Subjects and controls did not differ significantly in CASI, STAI-C, or CDI scores. Multiple regression analysis showed that both trait anxiety and CASI scores predicted CPTS-RI scores of the subjects; the prediction by CASI scores was over and above the effect of trait anxiety.

CONCLUSION

The results of this study support the hypothesis that AS may be a constitutional factor, which might increase the risk of PTSD following traumatic experiences.

Korean Anxiety Sensitivity Index-Revised: its factor structure, reliability, and validity in clinical and nonclinical samples

The factor structure and convergent and discriminant validity of the Anxiety Sensitivity Index-Revised (ASI-R) were examined in a community sample, a student sample, and patients with panic disorder in Korea. Results from a confirmatory factor analysis (CFA) comparing our data to factor solutions commonly reported as representative of European American populations indicated a poor fit. A subsequent exploratory factor analysis (EFA) indicated that a four-factor solution provided the best fit. Correlations between the ASI-R and anxiety measures were moderately high, providing evidence of convergent validity. Implications for assessment with Koreans are discussed.

Symptom Presentation and Symptom Meaning Among Traumatized Cambodian Refugees: Relevance to a Somatically Focused Cognitive-Behavior Therapy

Among psychologically distressed Cambodian refugees, somatic complaints are particularly prominent. Cambodians interpret anxiety-related somatic sensations in terms of "Wind" (khyâl), an ethnophysiology that gives rise to multiple catastrophic interpretations; and they have prominent trauma-memory associations to anxiety-related somatic symptoms. In this article, we detail some of the common sensation-related dysphoric networks of Cambodian refugees, focusing on catastrophic cognitions and trauma associations. We argue that delineating symptom-related dysphoric networks is crucial to successfully adapt cognitive-behavioral interventions to treat panic disorder and posttraumatic stress disorder among Cambodian refugees, and that such an approach may be useful for the culturally sensitive adaptation of cognitive-behavior therapy for other traumatized non-Western groups.

Psychological Correlates of Quality of Life in Atrial Fibrillation

OBJECTIVE

Atrial fibrillation (AF) is associated with significant health-related quality of life (QoL) impairments. Markers of heart disease severity have explained little variance in QoL and it is unclear what other factors will better account for the observed differences in adjustment. We examined whether specific personality traits and illness management styles would help explain the severity of QoL impairments reported in this population.

METHODS

Patients with AF (N = 93) completed validated questionnaires measuring disease burden (dependent variables: physical and mental QoL, symptom severity, psychological distress), personality (independent variables: anxiety sensitivity, optimism), and illness management style (mediating variable: symptom preoccupation). Hypothesized relationships were evaluated using mediation models.

RESULTS

Anxiety sensitivity was associated with poorer physical and mental QoL, greater symptom severity, and higher distress. Optimism was correlated with better mental QoL and lower distress, but unrelated to physical QoL and symptom severity. Symptom preoccupation significantly mediated the relationships between anxiety sensitivity and each of the QoL measures, as well as the relationships between optimism and mental well-being.

CONCLUSIONS

Personality traits and illness management styles are important to consider when assessing the impact of AF on QoL. The data support a cognitive-behavioral model that explains the direct and indirect relationships between psychological predictors and multiple indices of QoL.

Cognitive specificity of anxiety disorders: a review of selected key constructs

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.

The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale

BACKGROUND

Anxiety related to gastrointestinal sensations, symptoms or the contexts in which these may occur is thought to play a significant role in the pathophysiology as well as in the health outcomes of patients with irritable bowel syndrome.

AIM

To develop a valid and reliable psychometric instrument that measures gastrointestinal symptom-specific anxiety.

METHODS

External and internal expert panels as well as a patient focus group evaluated a large pool of potential item stems gathered from the psychological and gastrointestinal literature. Potential scale items were then administered to 96 patients diagnosed with irritable bowel syndrome along with a set of validating questionnaires. Final item selection was based upon rigorous empirical criteria and the psychometric properties of the final scale were examined.

RESULTS

A final unidimensional 15-item scale, the Visceral Sensitivity Index, demonstrated excellent reliability as well as good content, convergent, divergent and predictive validity.

CONCLUSIONS

The findings suggest that the Visceral Sensitivity Index is a reliable, valid measure of gastrointestinal symptom-specific anxiety that may be useful for clinical assessment, treatment outcome studies, and mechanistic studies of the role of symptom-related anxiety in patients with irritable bowel syndrome.

The facets of anxiety sensitivity represented in the childhood anxiety sensitivity index: confirmatory analyses of factor models from past studies

Results of past factor analytic studies of the Childhood Anxiety Sensitivity Index and Anxiety Sensitivity Index were used to formulate hypotheses about factor models of anxiety sensitivity. Using a nonclinical sample of 767 children and adolescents and confirmatory factor analysis, hypothesized models with 2, 3, and 4 lower order factors (facets) were tested. Goodness-of-fit criteria indicated that a model with 4 facets fits these data well. Support was found for factorial invariance of the 4 facets across age and gender, using nonclinical and clinical samples. Results support a hierarchical factor model in that there was a strong general factor, explaining 71% of the variance. Findings are discussed in the context of anxiety sensitivity theory and research with children and adolescents.