Anxiety sensitivity as a specific and unique marker of anxious symptoms in youth psychiatric inpatients

Intensive Cognitive-Behavioral Therapy for Anxiety Disorders in Adolescents: A Case Study

Anxiety disorders are one of the most common psychiatric conditions in youth and can contribute to impairment in social, academic, and family functioning. Cognitive-behavioral therapy (CBT) has been shown to be efficacious in treating youth anxiety disorders; however, for a multitude of reasons, fewer than 20% of adolescents with anxiety disorders receive services for anxiety-related problems. Intensive treatments, which rely on the same traditional components of CBT but are delivered over a shorter period of time or in a fewer number of sessions, may be particularly helpful for anxiety disorders and can offer a number of advantages over standard CBT. Despite emerging evidence supporting the advantages of the intensive approach, there are few established intensive treatment programs for youth with anxiety disorders. Further, no treatment to date has comprehensively targeted the entire spectrum of comorbid adolescent anxiety disorders in a combined intensive and transdiagnostic format, even though non-intensive (i.e., weekly delivered) CBT has been tested using a transdiagnostic approach. We developed an intensive, six-session intervention based on Angelosante and colleagues’ 2009 The Adolescent Panic Control Treatment with In-Vivo Exposures (Angelosante et al., 2009) and other empirically-supported treatments for youth to target all anxiety disorders in adolescents. We present a case study on an adolescent with multiple comorbid anxiety and related disorders who received intensive CBT treatment as a way to illustrate the clinical benefit and utility of an intensive, transdiagnostic approach. Findings support the acceptability and feasibility of transdiagnostic treatment of youth anxiety.

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.

Childhood anxiety sensitivity, fear downregulation, and anxious behaviors: Vagal suppression as a moderator of risk

Anxiety sensitivity-the fear that anxiety-related sensations will result in catastrophic physical, social, or psychological consequences-is a robust risk factor for clinical anxiety. However, less is known about how anxiety sensitivity may interact with physiological modulation of arousal to predict anxious children's fear responses. The present investigation examined vagal withdrawal as a moderator of the association between anxiety sensitivity and anxious children's ability to downregulate subjective feelings of fear in response to an anxiety-provoking speech task. Observer ratings of anxious behaviors and performance during the task were also examined. It was hypothesized that children's anxiety sensitivity levels would interact with respiratory sinus arrhythmia (RSA) suppression to explain unique variance in subjective fear downregulation, anxious behaviors, and task performance. Participants were 105 children with anxiety disorders (N = 105; M = 10.07 years, SD = 1.22; 57% female) who completed diagnostic interviews, questionnaires, a speech about their family, and an RSA assessment in baseline and speech conditions. Interactions between RSA suppression and anxiety sensitivity predicted unique variance in subjective fear downregulation. Specifically, the greatest difficulties downregulating subjective fear responses were exhibited by children with high anxiety sensitivity and low RSA suppression. Interactions between RSA suppression and anxiety sensitivity did not predict variance in observer ratings of anxious behaviors or task performance. However, higher baseline RSA and speech RSA were significantly associated with fewer anxious behaviors during the speech. Higher baseline RSA was also significantly associated with better speech performance. These findings highlight the importance of vagal withdrawal and its interaction with anxiety sensitivity in predicting downregulation of subjective fear among clinically anxious children. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the Hierarchical Influences of the Big-Five Dimensions and Anxiety Sensitivity on Anxiety Symptoms in Children

Anxiety sensitivity (AS), namely the fear of anxiety symptoms, has been described as a precursor of sub-threshold anxiety levels. Sexton et al. (2003) posited that increased AS would arise from an elevated neuroticism and that both would act as vulnerability factors for panic disorder (PD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) symptoms. Accordingly, this study aimed to (1) evaluate the applicability of this model to a pediatric population and (2) examine the influences of the other Big-Five personality dimensions on the four lower-order dimensions of AS (cognitive, physical, control, and physical) and on social phobia (SP), separation anxiety disorder (SAD) and depression symptoms. 200 children (104 girls) aged between 8 and 12 years old (mean age = 132.52 months, SD = 14.5) completed the Childhood Anxiety Sensitivity Index (Silverman et al., 1991), the Big Five Questionnaire for Children (Barbaranelli et al., 2003), and the Revised’s Children Anxiety and Depression Scale (Chorpita et al., 2000). Regression analyses confirmed that AS and neuroticism together significantly predicted the presence of PD, OCD, and GAD symptoms but also SP, SAD, and depression symptoms. Moreover, neuroticism interacted with extraversion, conscientiousness and agreeableness to significantly predict SP, GAD, and depression. Surprisingly, the global AS score was only predicted by agreeableness, while AS dimensions also specifically related to openness. Finally, AS dimensions did not predict the presence of specific anxiety symptoms. To conclude, the predicting model of anxiety symptoms in children sets neuroticism and AS on the same level, with an unexpected influence of agreeableness on AS, raising the importance of other trait-like factors in the definition of such models. Moreover, AS should be considered as a unitary construct when predicting the presence of anxiety symptoms in children. Future interventions must consider these associations to help children detect and recognize the symptoms of their anxiety and help them to interpret them correctly.

Do Youth with Separation Anxiety Disorder Differ in Anxiety Sensitivity From Youth with Other Anxiety Disorders?

Studies on the relationship between separation anxiety disorder (SAD) in childhood and panic disorder (PD) in adolescence and adulthood have yielded results which suggest a common underlying vulnerability for both disorders. In this study, we examined whether one such possible vulnerability-anxiety sensitivity-differed for youth diagnosed with SAD versus other anxiety disorders. Anxiety sensitivity was assessed using the Childhood Anxiety Sensitivity Index (CASI) in 315 clinic-referred youth (ages 6-17, 113 girls). 145 children (46%) were diagnosed with one or more primary anxiety disorder, including SAD (n = 22), generalized anxiety (GAD) (n = 79), social anxiety (SocA) (n = 55), and specific phobia (SP) (n = 45). Children with SAD reported higher levels of anxiety sensitivity and fears of physical symptoms than children with SP and SocA, but not children with GAD. We speculate that children who have SAD and GAD and high anxiety sensitivity may be more vulnerable to develop PD.

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.

The experience of perimenopausal distress: examining the role of anxiety and anxiety sensitivity

OBJECTIVE

The hormonal changes that occur in perimenopause can result in distress for a significant proportion of women years before reaching menopause. Previous studies have suggested that various biopsychosocial characteristics and personality traits contribute to more intense reactions to these hormonal changes. In the present study, we examined the contribution of trait anxiety and anxiety sensitivity in predicting the experience of perimenopausal distress in pre- and early perimenopausal women while controlling for some menstrual experiences.

METHOD

A sample of 660 women aged 35-52 years was selected from a broader online survey of biopsychosocial changes in middle-aged women that considered age, menstrual cycle pattern, physical and mental health, and childbearing experience. Three hierarchical multiple regression analyses were conducted for different age subgroups: women aged 35-40, women aged 41-45 and women aged 46-52.

RESULTS

Results indicated that anxiety and anxiety sensitivity, along with a number of features of the menstrual experience, explained 56-66% of the perimenopausal distress variance. Different personality trait predictors were found to be important in different age subgroups. In the youngest and middle subgroups (45 years and younger), trait anxiety was found to be more significant, whereas anxiety sensitivity was found to be more important in explaining perimenopausal distress experienced by women older than 40.

CONCLUSION

Anxiety sensitivity (dimension of psychological concerns) might be an important vulnerability factor in the experience of perimenopausal distress among women closer to menopause, whereas the predisposition to an anxiety response might contribute to perimenopausal distress near the beginning of reproductive hormonal changes. Implications for better understanding the development of perimenopausal distress and psychological intervention are discussed.

Cognitive Errors, Anxiety Sensitivity, and Anxiety Control Beliefs

This study examined the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and explored their unique and specific associations with anxiety symptoms in a community sample of youth. Existing research has suggested that these constructs are related to childhood anxiety disorder symptoms; however, additional research is needed to test the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and to determine if they show unique and specific associations with anxiety symptoms. The results of this study indicated that negative cognitive errors, anxiety sensitivity, and anxiety control beliefs were associated with each other and that they demonstrated unique concurrent associations with childhood anxiety disorder symptoms. Moreover, certain cognitive biases showed specificity in their association with anxiety symptoms versus depressive symptoms.

Factor Structure and Psychometric Properties of the Anxiety Sensitivity Index-3 in an Italian Community Sample

Anxiety Sensitivity (AS) is defined as the fear of anxiety and of arousal-related bodily sensations, arising from erroneous beliefs that these sensations will have adverse consequences. AS plays a key role both in the onset and in the maintenance of several disorders, particularly anxiety disorders. To date, only two studies on American samples have examined the bifactor structure of the Anxiety Sensitivity Index-3 (ASI-3); therefore, findings on different cultures are needed. The main purpose of the present study was to assess the factor structure and psychometric properties of the ASI-3 in an Italian community sample. Participants were recruited from the general population (N = 1507). The results of a series of confirmatory factor analyses indicated that the bifactor structure fitted the data better than the most commonly accepted structure for the measure and that it was invariant across gender. Moreover, the current study provided evidence regarding the ASI-3’s reliability and its convergent and divergent validity. Lastly, results pertaining incremental validity of the ASI-3 Physical and Cognitive Concerns subscales above and beyond the total showed that the former was not associated with a measure of physiological anxiety, whereas the latter was weakly associated with a measure of worry. Findings suggest that the ASI-3 is comprised of a dominant general factor and three specific independent factors; given the dominance of the general factor, the use of the ASI-3 total score as a measure of the general fear of anxiety is recommended in both clinical and research settings.

The interpersonal theory of suicide and adolescent suicidal behavior

BACKGROUND

Joiner's interpersonal theory of suicide (IPTS) proposes that suicide results from the combination of a perception of burdening others, social alienation, and the capability for self-harm. The theory gained some empirical support, however the overall model has yet to be tested. This study aimed to test the main predictions of IPTS in a large community sample of Israeli adolescents.

METHOD

1196 Israeli Jewish and Arab high-school pupils participating in the SEYLE project completed a self-report questionnaire measuring perceived burdensomeness, thwarted belongingness, health risk behaviors, and non-suicidal self-injury (risk variables), and suicidal ideation and suicide attempts (outcome measures). The data were tested in cross-sectional regression models.

RESULTS

Consistent with IPTS, perceived burdensomeness was found to interact with thwarted belongingness, predicting suicidal ideation. Depression mediated most of the effect of thwarted belongingness and perceived burdensomeness on suicidal ideation. Acquired capability for self-harm, as measured by health risk behaviors and direct non-suicidal self-injurious behaviors, predicted suicide attempt. However, this mechanism operated independently from ideation rather than in interaction with it, at variance with IPTS-based predictions.

LIMITATIONS

The cross-sectional design precludes conclusions about causality and directionality. Proxy measures were used to test the interpersonal theory constructs.

CONCLUSION

The findings support some of the IPTS predictions but not all, and imply two separate pathways for suicidal behavior in adolescents: one related to internalizing psychopathology and the other to self-harm behaviors. This conceptualization has clinical implications for the differential identification of adolescents at risk for suicidal behavior and for the development of prevention strategies.

Identifying Moderators of the Link Between Parent and Child Anxiety Sensitivity: The Roles of Gender, Positive Parenting, and Corporal Punishment

A substantial body of literature suggests that anxiety sensitivity is a risk factor for the development of anxiety problems and research has now begun to examine the links between parenting, parent anxiety sensitivity and their child's anxiety sensitivity. However, the extant literature has provided mixed findings as to whether parent anxiety sensitivity is associated with child anxiety sensitivity, with some evidence suggesting that other factors may influence the association. Theoretically, specific parenting behaviors may be important to the development of child anxiety sensitivity and also in understanding the association between parent and child anxiety sensitivity. In this study, 191 families (n = 255 children and adolescents aged 6-17 and their parents) completed measures of child anxiety sensitivity (CASI) and parenting (APQ-C), and parents completed measures of their own anxiety sensitivity (ASI) and their parenting (APQ-P). Corporal punishment was associated with child anxiety sensitivity and the child's report of their parent's positive parenting behaviors moderated the association between parent and child anxiety sensitivity. The child's gender was also found to moderate the association between parent and child anxiety sensitivity, such that there was a positive association between girls' and their parents anxiety sensitivity and a negative association in boys. The findings advance the understanding of child anxiety sensitivity by establishing a link with corporal punishment and by showing that the association between parent and child anxiety sensitivity may depend upon the parenting context and child's gender.

Cognitive content specificity in anxiety and depressive disorder symptoms: a twin study of cross-sectional associations with anxiety sensitivity dimensions across development

BACKGROUND

The classification of anxiety and depressive disorders has long been debated and has important clinical implications. The present study combined a genetically sensitive design and multiple time points to investigate cognitive content specificity in anxiety and depressive disorder symptoms across anxiety sensitivity dimensions, a cognitive distortion implicated in both disorders.

METHOD

Phenotypic and genetic correlations between anxiety sensitivity dimensions, anxiety and depressive disorder symptoms were examined at five waves of data collection within childhood, adolescence and early adulthood in two representative twin studies (n pairs = 300 and 1372).

RESULTS

The physical concerns dimension of anxiety sensitivity (fear of bodily symptoms) was significantly associated with anxiety but not depression at all waves. Genetic influences on physical concerns overlapped substantially more with anxiety than depression. Conversely, mental concerns (worry regarding cognitive control) were phenotypically more strongly associated with depression than anxiety. Social concerns (fear of publicly observable symptoms of anxiety) were associated with both anxiety and depression in adolescence. Genetic influences on mental and social concerns were shared to a similar extent with both anxiety and depression.

CONCLUSIONS

Phenotypic patterns of cognitive specificity and broader genetic associations between anxiety sensitivity dimensions, anxiety and depressive disorder symptoms were similar at all waves. Both disorder-specific and shared cognitive concerns were identified, suggesting it is appropriate to classify anxiety and depression as distinct but related disorders and confirming the clinical perspective that cognitive therapy is most likely to benefit by targeting cognitive concerns relating specifically to the individual's presenting symptoms across development.

Developmental trajectories of anxiety symptoms in early adolescence: the influence of anxiety sensitivity

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M age = 11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.

Cognitive Vulnerabilities for Depression and Anxiety in Childhood: Specificity of Anxiety Sensitivity and Rumination

Background: Childhood anxiety and depression frequently co-occur. Exploring specificity in cognitive processes for anxiety and depression in childhood can provide insight into cognitive vulnerabilities contributing to the development of anxiety and depressive disorders and inform targeted psychological interventions. Anxiety sensitivity and rumination are robust cognitive vulnerabilities for anxiety and depression, respectively. However, despite conceptual similarities, they are rarely considered together within a single study. Aims: The current study explored specific and shared associations between anxiety sensitivity subscales and rumination and anxiety and depressive symptoms in unselected children. Method: Multiple regression analyses explored to what extent specific self-reported anxiety sensitivity subscales (physical, social and mental concerns) and rumination predicted anxiety and depressive symptoms in 147 unselected children, aged 7–11 years. Results: Physical and social concern subscales of anxiety sensitivity were specifically associated with anxiety, whilst rumination was specifically associated with depressive symptoms. The mental concerns subscale of anxiety sensitivity was independently associated with both anxiety and depressive symptoms. These associations were only partially mediated by rumination. Conclusions: Anxiety and depression in young people are characterized by specific and shared cognitions. Evidence for shared and specific associations between the cognitive vulnerabilities of anxiety sensitivity and rumination, and anxiety and depression highlight the utility of transdiagnostic research and confirm that cognitive therapies may benefit from targeting cognitive concerns relating specifically to the patient's presenting symptoms.

Somatic, but not cognitive, symptoms of anxiety predict lower levels of physical activity in panic disorder patients

BACKGROUND

Anxiety disorders have gathered much attention as possible risk factors for the development of cardiovascular disease (CVD), possibly mediated by an unhealthy lifestyle (e.g. low physical activity). However, prospective studies on anxiety disorders and CVD show conflicting results. A possible explanation is that somatic symptoms of anxiety may have a more specific cardiovascular effect than cognitive symptoms across different anxiety disorders. The present study investigated the association between cognitive and somatic symptoms of anxiety and physical activity (PA) in a sample of panic disorder (PD) outpatients.

METHODS

One-hundred and two outpatients with a lifetime diagnosis of PD from a previously studied cohort were contacted. Patients were evaluated throughout the MINI, the Beck Anxiety Inventory (BAI) and the International Physical Activity Questionnaire (IPAQ). After performing a multivariate regression analysis, groups were divided into high and low somatic anxiety.

RESULTS

Patients with high somatic anxiety showed a significantly higher prevalence of low level of PA as compared to those with low somatic anxiety (62.5 versus 34.3%; χ²= 5.33; df=1; P=.021). Somatic symptoms of anxiety remained the only important predictors of low level of PA (odds ratio [OR] 2.81; 95% CI 1.00-7.90; p=.050) in the multivariate model.

LIMITATIONS

The main limitations of the present study are the cross-sectional design and the small sample size.

CONCLUSIONS

Results support specific effects of somatic symptoms of anxiety on risk for low level of PA, which might explain inconsistent results regarding CVD risk in the literature.

Anxiety and anxiety sensitivity as predictors of fear of childbirth: different patterns for nulliparous and parous women

OBJECTIVE

The demographic characteristics, maternal parity and personal traits of pregnant women have been frequently studied predictors of fear of childbirth (FOC). The aim of this study was to examine the role of demographic variables, expected pain level, trait anxiety and anxiety sensitivity in FOC among nulliparous and multiparous women in the last trimester of pregnancy.

METHOD

Two-hundred pregnant women completed a booklet with questionnaires including the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), Anxiety Sensitivity Index (ASI), The State - Trait Anxiety Inventory (STAI) and questions on expected labor pain and demographics.

RESULTS

Results showed that FOC was higher amongst nulliparous women, but FOC level was not associated with other demographic variables. Different predictors were established in nulliparous and multiparous women. While higher intensity of expected labor pain and anxiety sensitivity (dimension physical concern) were significant predictors in both groups, trait anxiety was significant for the first-time mothers only.

CONCLUSION

Amongst all women, anxiety sensitivity (physical concerns dimension) was identified as an important vulnerability factor for FOC. As such, the level of anxiety sensitivity, and any resulting fear or expectations of pain, should be assessed in expectant mothers by clinicians in prenatal settings. Furthermore, anxiety sensitivity should be an important target for psychological interventions aimed at managing FOC.

Childhood trauma and adult interpersonal relationship problems in patients with depression and anxiety disorders

INTRODUCTION

Although a plethora of studies have delineated the relationship between childhood trauma and onset, symptom severity, and course of depression and anxiety disorders, there has been little evidence that childhood trauma may lead to interpersonal problems among adult patients with depression and anxiety disorders. Given the lack of prior research in this area, we aimed to investigate characteristics of interpersonal problems in adult patients who had suffered various types of abuse and neglect in childhood.

METHODS

A total of 325 outpatients diagnosed with depression and anxiety disorders completed questionnaires on socio-demographic variables, different forms of childhood trauma, and current interpersonal problems. The Childhood Trauma Questionnaire (CTQ) was used to measure five different forms of childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and the short form of the Korean-Inventory of Interpersonal Problems Circumplex Scale (KIIP-SC) was used to assess current interpersonal problems. We dichotomized patients into two groups (abused and non-abused groups) based on CTQ score and investigated the relationship of five different types of childhood trauma and interpersonal problems in adult patients with depression and anxiety disorders using multiple regression analysis.

RESULT

Different types of childhood abuse and neglect appeared to have a significant influence on distinct symptom dimensions such as depression, state-trait anxiety, and anxiety sensitivity. In the final regression model, emotional abuse, emotional neglect, and sexual abuse during childhood were significantly associated with general interpersonal distress and several specific areas of interpersonal problems in adulthood. No association was found between childhood physical neglect and current general interpersonal distress.

CONCLUSION

Childhood emotional trauma has more influence on interpersonal problems in adult patients with depression and anxiety disorders than childhood physical trauma. A history of childhood physical abuse is related to dominant interpersonal patterns rather than submissive interpersonal patterns in adulthood. These findings provide preliminary evidence that childhood trauma might substantially contribute to interpersonal problems in adulthood.

The role of parental anxiety sensitivity in parent reports of child anxiety in treatment seeking families

Recent research has examined the contribution of parental anxiety sensitivity to child anxiety, suggesting only a modest relationship between these two variables. No study to date, however, has examined the role of parental anxiety sensitivity in parent reports of the child's anxiety. It was hypothesized that anxiety sensitivity, a cognitive risk factor for the development of anxiety, would be significantly correlated with parents' reports of their child's anxiety, specifically with respect to panic and separation anxiety. The present study employed a sample of 56 treatment-seeking children and their parents. Parent and child reports of the child's anxiety were obtained, and self-reports of anxiety sensitivity were obtained from parent and child. Parent reports of their child's panic and separation anxiety symptoms were significantly related to not only parental anxiety sensitivity (r = .39 and r = .29, respectively) but also the child's self-reported level of anxiety sensitivity (r = .35 and r = .37, respectively). These findings suggest that anxiety sensitivity, a significant predictor of panic symptomatology amongst both adults and children, might be related to parents' perceptions of their child's symptoms of panic and separation anxiety. These findings further suggest taking into consideration parental levels of anxiety sensitivity when interpreting parent reports of child anxiety in clinical settings.

Psychological models of suicide

Suicidal behavior is highly complex and multifaceted. Consequent to the pioneering work of Durkheim and Freud, theoreticians have attempted to explain the biological, social, and psychological nature of suicide. The present work presents an overview and critical discussion of the most influential theoretical models of the psychological mechanisms underlying the development of suicidal behavior. All have been tested to varying degrees and have important implications for the development of therapeutic and preventive interventions. Broader and more in-depth approaches are still needed to further our understanding of suicidal phenomena.

An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children

Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.

Factor Structure and Psychometric Properties of the Anxiety Sensitivity Index in a Sample of Croatian Adults

Anxiety sensitivity (AS) refers to a person’s tendency to fear anxiety-related symptoms due to the belief that these symptoms may have harmful consequences. The most widely used operationalization of AS in adults is the Anxiety Sensitivity Index (ASI). The factor structure, gender stability, and psychometric properties of the ASI in a sample of Croatian adults ( N = 984) were evaluated. Results confirm the multidimensional and hierarchical structure of the ASI, which consisted of three lower-order factors (Physical Concerns, Psychological Concerns, and Social Concerns) and a single higher-order factor, AS. Furthermore, the achievement of normative scores for the ASI in a Croatian adult sample demonstrates the cross-national stability of the ASI. Reliability coefficients for the ASI, Physical Concerns, and Psychological Concerns are high and satisfactory in the total sample and for both genders. Overall, the results confirmed the cross-national stability, gender stability, reliability, and validity of the ASI in a sample of Croatian adults.

Parental contributions to child anxiety sensitivity: a review and recommendations for future directions

Anxiety sensitivity (AS) is defined as the fear of anxiety-related symptoms (e.g., a fast beating heart) and the consequences that may follow from these symptoms (e.g., a heart attack). Recently, child AS has been examined in relation to parental AS and parental anxiety to elucidate potential parental contributions. Given inconsistent findings to date, this review was intended to identify parental factors that are significant contributors to child AS. Two key findings from this review included the absence of a significant relationship between parental anxiety and child AS and the determination that the parent-child AS association is conditional upon the child reporter, the parent reporter, and the specific dimensions of AS being tested. Recommendations for future directions include examining specific facets of AS, studying parental contributions amongst anxiety-disordered youth, and employing sufficiently large samples to allow for between child group comparisons.

Anxiety sensitivity: prospective prediction of anxiety among early adolescents

Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks as well as clinical syndromes in adult samples. The primary aim of the present study was to determine whether AS similarly acts as a vulnerability factor in the pathogenesis of anxiety symptoms among youth in early adolescence (ages 9-13). A large nonclinical community sample of youth (n=277) was prospectively followed over 1 year. The Childhood Anxiety Sensitivity Index (CASI: Silverman, Fleisig, Rabian, & Peterson, 1991) served as the primary predictor. After controlling for baseline anxiety symptoms as well as depression, AS significantly predicted the future development of anxiety symptoms. Consistent with the adult literature and expectancy theory, AS appears to act as a risk factor for anxiety symptoms in youth.

Evidence-Based Assessment of Anxiety and Its Disorders in Children and Adolescents

We provide an overview of where the field currently stands when it comes to having evidence-based methods and instruments available for use in assessing anxiety and its disorders in children and adolescents. Methods covered include diagnostic interview schedules, rating scales, observations, and self-monitoring forms. We also discuss the main purposes or goals of assessment and indicate which methods and instruments have the most evidence for accomplishing these goals. We also focus on several specific issues that need continued research attention for the field to move forward toward an evidence-based assessment approach. Finally, tentative recommendations are made for conducting an evidence-based assessment for anxiety and its disorders in children and adolescents. Directions for future research also are discussed.

A cross-sectional evaluation of the factorial invariance of anxiety sensitivity in adolescents and young adults

This study examined the cross-sectional factorial invariance of anxiety sensitivity in an ethnically diverse sample of adolescents (n = 173; mean age 15.5 years) and young adults (n = 291; mean age 20.1 years). Research in adult and youth samples suggests that anxiety sensitivity is best understood as a hierarchical construct with several lower-order factors. Factor models based on previous research using both adult and youth samples were compared and a hierarchical model with three lower-order factors provided the best fit to the data. Results supported the hypothesis that the factor structure of the Anxiety Sensitivity Index was invariant across age and gender. The factor scores also demonstrated differential correlations with symptoms of anxiety and depression. Results are discussed with regard to construct validation and understanding the structure of anxiety sensitivity in youth.

Anxiety sensitivity in African-American adolescents: evidence of symptom specificity of anxiety sensitivity components

OBJECTIVE

To examine the specificity of components of anxiety sensitivity (phrenophobia, fear of cardiovascular sensations, and fear of unsteadiness) to anxiety and depression in a sample of African-American adolescents.

METHOD

Participants were 527 African-American adolescents (238 females, mean age 13.8 years) who were originally recruited as first graders in 1993 to 1994 for participation in the second-generation Johns Hopkins Prevention Intervention Research Center trials. Youths completed measures of anxiety sensitivity and anxious and depressive symptoms in the spring of 2001. Associations between anxiety sensitivity and depression and anxiety were examined using hierarchical linear regressions.

RESULTS

Anxiety sensitivity as a unitary construct was positively associated with symptoms of anxiety after adjusting for symptoms of depression. Fear of unsteadiness showed specificity to anxiety after adjusting for depression and phrenophobia. Phrenophobia was positively associated with anxiety and depression, after adjusting for the other symptom and fears of physical sensations.

CONCLUSIONS

Specificity of anxiety sensitivity to anxiety in a sample of African-American adolescents furthers understanding of the nature of anxiety sensitivity in this group and the potential roles of components of anxiety sensitivity in the development of psychopathology in general.

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.