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Foell A, Pitzer KA, Nebbitt V, Lombe M, Yu M, Villodas ML, Enelamah N, Lateef H. Anxiety sensitivity among Black youth: A cross-sectional analysis of the direct and indirect effects of community violence exposure, neighborhood risk, parenting practices, and peer effects. J Natl Med Assoc 2024; 116:390-402. [PMID: 39068110 DOI: 10.1016/j.jnma.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/01/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024]
Abstract
Youth exposed to community violence and neighborhood stressors report devastating mental health consequences. Black youth are at greater risk and experience community violence at rates higher than other youth populations. An underexplored mental health consequence is anxiety sensitivity, the fear of experiencing anxiety-related symptoms, which contributes to maladaptive coping strategies and the development and severity of other mental health problems. This study utilized structural equation modeling (SEM) to examine socio-ecological risk and protective factors associated with community violence exposure and anxiety sensitivity among low-income Black youth. Survey data are from a sample of 320 Black youth residing in public and subsidized housing in a Northeastern city in the United States. Results indicated that neighborhood risk, parenting behaviors, and exposure to delinquent peers were indirectly associated with anxiety sensitivity, which occurred through community violence exposure. Additionally, neighborhood risks had direct effects on anxiety sensitivity. Results point to the need to incorporate social and environmental factors in interventions addressing anxiety sensitivity among Black youth in urban communities.
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Affiliation(s)
- Andrew Foell
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street, Chicago, IL 60607, USA.
| | - Kyle A Pitzer
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130, USA
| | - Von Nebbitt
- School of Social Work, Morgan State University, 1700 E. Cold Spring Lane, Baltimore, MD 21251, USA
| | - Margaret Lombe
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA 02215, USA
| | - Mansoo Yu
- School of Social Work, Department of Public Health, University of Missouri, 720 Clark Hall, Columbia, MO 65211, USA
| | - Melissa L Villodas
- Department of Social Work, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA
| | - Ngozi Enelamah
- Department of Social Work, University of New Hampshire, 55 College Road, Durham, NH 03824, USA
| | - Husain Lateef
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130, USA
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Schiele MA, Vietz M, Gajewska A, Unterecker S, Gottschalk MG, Deckert J, Neufang S, Schmidt NB, Domschke K. The cognitive anxiety sensitivity treatment (CAST) in anxiety prevention - Focus on separation anxiety and interoception. Eur Neuropsychopharmacol 2021; 53:104-113. [PMID: 34536714 DOI: 10.1016/j.euroneuro.2021.08.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 01/04/2023]
Abstract
Given the high prevalence and considerable clinical and societal burden of anxiety disorders, preventive measures are urgently warranted to reduce their incidence and overall healthcare impact. Anxiety sensitivity (AS) - a key element in learning theories of anxiety disorders in the context of interoceptive conditioning - constitutes a malleable risk factor of particularly panic disorder and separation anxiety, which share developmental, nosological, epidemiological and pathomechanistic characteristics. The computer-assisted 'Cognitive Anxiety Sensitivity Treatment' (CAST) targeting interoceptive anxiety symptoms (cf. Schmidt et al., 2014) was translated, intensified and culturally adapted to German and evaluated in a sample of 105 healthy adult volunteers with elevated AS (mean ASI-3: 29.5) applying a randomized design. Success of the intervention was measured as a function of AS and separation anxiety (ASA-27) ∼6 weeks (T1) and ∼6 months (T2) after the intervention. As compared to waitlist, CAST resulted in a significant reduction of AS at both T1 and T2. Separation anxiety was not directly reduced by the intervention, but decreased mediated by a decline in AS. A composite interoceptive score capturing changes in sensitivity to respiratory symptoms during the baseline therapist-accompanied CAST session was shown to be predictive of overall response at T1. In sum, CAST-German Version was successfully established as an effective intervention reducing AS, while at the same time indirectly decreasing separation anxiety. A composite interoceptive score predicting treatment response might aid in further delineating risk markers informing targeted preventive interventions for anxiety disorders.
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Affiliation(s)
- Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Vietz
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Agnieszka Gajewska
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Michael G Gottschalk
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany,; Comparative Psychology, Institute of Experimental Psychology, Heinrich-Heine University, Düsseldorf, Germany
| | - Norman B Schmidt
- Florida State University, Department of Psychology, Tallahassee, FL, USA
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Raines EM, Viana AG, Trent ES, Conroy HE, Woodward EC, Zvolensky MJ, Storch EA. The explanatory role of anxiety sensitivity in the association between effortful control and child anxiety and depressive symptoms. Cogn Behav Ther 2020; 49:501-517. [PMID: 32692282 PMCID: PMC7581554 DOI: 10.1080/16506073.2020.1790644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/15/2020] [Indexed: 12/27/2022]
Abstract
The present study examined the underlying role of anxiety sensitivity in the association between effortful control and anxiety and depressive symptoms in a sample of clinically anxious children. It was hypothesized that effortful control would exert an indirect effect through anxiety sensitivity in relation to child anxiety and depressive symptoms. Clinically anxious children (N= 105; Mage = 10.09 years, SD = 1.22; 56.7% female; 61% ethnic minority) and their mothers completed a diagnostic interview and a battery of questionnaires that included self- and mother-ratings of child effortful control, anxiety sensitivity, and anxiety and depressive symptoms. The indirect effect of effortful control via anxiety sensitivity on child anxiety and depressive symptoms was significant across child- and mother-completed measures. Among clinically anxious youth, greater effortful control was related to lower anxiety sensitivity, which was related to lower anxiety and depressive symptoms. Future work should evaluate whether targeting effortful control leads to clinically meaningful reductions in anxiety sensitivity and child anxiety and depressive symptoms.
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Affiliation(s)
| | - Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX, 77204
- Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, 77204
| | - Erika S. Trent
- Department of Psychology, University of Houston, Houston, TX, 77204
| | - Haley E. Conroy
- Department of Psychology, University of Houston, Houston, TX, 77204
| | - Emma C. Woodward
- Department of Psychology, University of Houston, Houston, TX, 77204
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, 77204
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric A. Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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The Role of Anxiety Sensitivity in the Relationship Between Emotion Dysregulation and Internalizing Psychopathology Among Trauma-Exposed Inpatient Adolescents. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9943-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mathews BL, Koehn AJ, Abtahi MM, Kerns KA. Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review. Clin Child Fam Psychol Rev 2017; 19:162-84. [PMID: 27072682 DOI: 10.1007/s10567-016-0204-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
| | - Amanda J Koehn
- Kent State University, 600 Hilltop Dr., Kent Hall, Kent, OH, 4424, USA
| | | | - Kathryn A Kerns
- Kent State University, 600 Hilltop Dr., Kent Hall, Kent, OH, 4424, USA
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Perceptions of racism and depressive symptoms in African American adolescents: the role of perceived academic and social control. J Youth Adolesc 2009; 38:519-31. [PMID: 19636725 DOI: 10.1007/s10964-009-9393-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
Abstract
Experiences with racism are a common occurrence for African American youth and may result in negative self perceptions relevant for the experience of depressive symptoms. This study examined the longitudinal association between perceptions of racism and depressive symptoms, and whether perceived academic or social control mediated this association, in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling revealed that experiences with racism were associated with low perceived academic control, which in turn was associated with increased depressive symptoms. Findings suggest that experiences with racism can have long lasting effects for African American youth's depressive symptoms, and highlight the detrimental effects of experiences with racism for perceptions of control in the academic domain. Implications for intervention are discussed.
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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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Schmidt NB, Zvolensky MJ. Anxiety sensitivity and CO2 challenge reactivity as unique and interactive prospective predictors of anxiety pathology. Depress Anxiety 2008; 24:527-36. [PMID: 17136755 DOI: 10.1002/da.20267] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Emerging evidence suggests that anxiety sensitivity (AS) and CO(2)-induced fear reactivity are associated with panic attacks and anxiety disorders. However, evidence regarding the unique and potentially synergistic effects of these variables is currently lacking. Our primary aims in this study were to determine whether AS and CO(2)-induced fear reactivity are unique and potentially interactive vulnerability factors involved in the pathogenesis of panic attacks and anxiety psychopathology. A large nonclinical sample of young adults (N=404) was prospectively followed over approximately 2 years. AS (i.e., 16-item Anxiety Sensitivity Index total scores) and biological challenge reactivity [i.e., fearful responding to pre- and postchallenge changes in subjective units of distress (SUDS) to a 20-s 20% CO(2) challenge] at study entry served as the primary predictor variables. Consistent with expectation, AS and challenge reactivity correlated only moderately with one another. Challenge reactivity was uniquely associated with the development of spontaneous panic attacks, whereas AS was uniquely associated with anxiety disorder diagnoses, including panic disorder. Moreover, the combination of both risk factors predicted spontaneous panic attacks beyond the effects of either risk factor individually. These data provide novel evidence for the unique and combined effects of AS and CO(2)-induced fear reactivity as risk factors in the development of anxiety and its disorders.
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Affiliation(s)
- Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida 32306-1270, USA.
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Schmidt NB, Eggleston AM, Woolaway-Bickel K, Fitzpatrick KK, Vasey MW, Richey JA. Anxiety Sensitivity Amelioration Training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability. J Anxiety Disord 2007; 21:302-19. [PMID: 16889931 DOI: 10.1016/j.janxdis.2006.06.002] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 06/06/2006] [Accepted: 06/09/2006] [Indexed: 11/21/2022]
Abstract
Fear of arousal symptoms, often referred to as anxiety sensitivity (AS) appears to be associated with risk for anxiety pathology and other Axis I conditions. Findings from a longitudinal prevention program targeting AS are reported. Participants (n=404) scoring high on the Anxiety Sensitivity Index (ASI) were randomly assigned to receive a brief intervention designed to reduce AS (Anxiety Sensitivity Amelioration Training (ASAT)) or a control condition. Participants were followed for up to 24 months. Findings indicate that ASAT produced greater reductions in ASI levels compared with the control condition. Moreover, reductions were specific to anxiety sensitivity relative to related cognitive risk factors for anxiety. ASAT also produced decreased subjective fear responding to a 20% CO(2) challenge delivered postintervention. Data from the follow-up period show a lower incidence of Axis I diagnoses in the treated condition though the overall group difference was not statistically different at all follow-up intervals. Overall, findings are promising for the preventative efficacy of a brief, computer-based intervention designed to decrease anxiety sensitivity.
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Affiliation(s)
- Norman B Schmidt
- Florida State University, Department of Psychology, Tallahassee, FL 32306, USA.
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Schmidt NB, Buckner JD, Keough ME. Anxiety sensitivity as a prospective predictor of alcohol use disorders. Behav Modif 2007; 31:202-19. [PMID: 17307935 DOI: 10.1177/0145445506297019] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emerging evidence suggests that elevated anxiety sensitivity (AS) is associated with substance use disorders. However, prospective evidence regarding this association is currently lacking. The primary aim of the present study was to determine whether AS is involved in the pathogenesis of substance-related psychopathology. A large, nonclinical sample of young adults (N = 404) was prospectively followed for approximately 2 years. AS (i.e., 16-item Anxiety Sensitivity Index total scores) at study entry and gender served as the primary predictor variables. Findings indicated that AS was uniquely associated with the later development of alcohol use disorder diagnoses. Data indicated that gender and AS did not act synergistically to predict alcohol use disorders. These data provide novel evidence for the unique effects of AS as a prospective risk factor in the development of alcohol-related disorders.
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Affiliation(s)
- Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL 32306-1270, USA.
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Schmidt NB, Zvolensky MJ, Maner JK. Anxiety sensitivity: prospective prediction of panic attacks and Axis I pathology. J Psychiatr Res 2006; 40:691-9. [PMID: 16956622 DOI: 10.1016/j.jpsychires.2006.07.009] [Citation(s) in RCA: 348] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 07/07/2006] [Accepted: 07/18/2006] [Indexed: 11/30/2022]
Abstract
Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks. However, evidence regarding whether AS serves as a premorbid risk factor for the development of clinical syndromes is lacking. The primary aim of the present study was to determine whether AS acts as a vulnerability factor in the pathogenesis of psychiatric diagnoses. A large nonclinical sample of young adults (N=404) was prospectively followed over two years. The Anxiety Sensitivity Index (ASI: Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy 1986; 24: 1-8.) and trait anxiety served as predictors. Consistent with prior reports, AS predicted the development of spontaneous panic attacks in those with no history of panic. Importantly, AS was found to predict the incidence of anxiety disorder diagnoses and overall Axis I diagnoses in those with no history of Axis I diagnoses at study entry. These are the first data to provide strong prospective evidence for AS as a risk factor in the development of anxiety disorders.
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Affiliation(s)
- Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, 32306, USA.
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Bibliography. Current world literature. Child and Adolescent psychiatry. Curr Opin Psychiatry 2005; 18:455-66. [PMID: 16639142 DOI: 10.1097/01.yco.0000172068.09144.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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