Thorn in Your Side or Thorn in Your Head? Anxiety and Stress as Correlates of Exercise-Related Transient Abdominal Pain

OBJECTIVES

The etiology of exercise-related transient abdominal pain (ETAP) is not congruent among researchers notwithstanding numerous studies on the matter. No pursuit has sought to correlate ETAP with factors such as anxiety, stress, sleep dysfunction, and pain sensitivity that are linked to other gastrointestinal (GI) disturbances in athletes.

DESIGN

Cross-sectional observational study involving an anonymous survey.

SETTING

Online.

PARTICIPANTS

One hundred sixty-eight male and female adults running at least 10 miles/wk.

ASSESSMENTS OF RISK FACTORS

Age, body mass index, years of running experience, GI symptoms, the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), Perceived Stress Scale (PSS)-14, Sleep Problems Index-I, and Pain Sensitivity Questionnaire.

MAIN OUTCOMES

Exercise-related transient abdominal pain prevalence over the past month as well as ETAP severity and frequency.

RESULTS

Exercise-related transient abdominal pain occurred in 39.9% of participants at least once in the past month. Exercise-related transient abdominal pain-positive runners were significantly younger and less experienced than ETAP-negative runners. Exercise-related transient abdominal pain-positive runners demonstrated higher resting and running-related GI symptoms, PSS-14, and STICSA scores compared with ETAP-negative runners. After accounting for age and experience, the ETAP-positive group had STICSA and PSS-14 scores that were 3.4 [95% confidence interval (CI), 1.0-5.8] and 4.1 (95% CI, 1.2-6.0) points higher, respectively, than the ETAP-negative group. State-Trait Inventory for Cognitive and Somatic Anxiety scores were significantly, modestly correlated (ρ = 0.27, P = 0.03) with ETAP frequency but not severity in runners who were ETAP-positive.

CONCLUSIONS

In runners, this is the first investigation to reveal that anxiety and stress are associated with the presence of ETAP.

Metacognitive Beliefs about Uncontrollability Relate Most Strongly to Health Anxiety among U.S.-based non-Latinx White Primary Care Patients: Comparing Strength of Relations with U.S.-based non-Latinx Black and Latinx Primary Care Patients

Metacognitive beliefs have emerged as important to health anxiety, particularly beliefs that health-related thoughts are uncontrollable. Preliminary research examining generalized worry indicates uncontrollability beliefs relate more strongly to anxiety among U.S.-based self-identifying White relative to Black college students. The present study sought to extend that line of research by examining if metacognitive beliefs about the uncontrollability of health-related thoughts differentially relate to health anxiety among self-identifying non-Latinx Black (n = 123), Latinx (n = 104), and non-Latinx White (n = 80) U.S.-based primary care patients. As predicted, although positive associations were seen across all three groups, beliefs that health-related thoughts are uncontrollable more strongly related to health anxiety among White patients compared to both Black and Latinx patients. Those differential relations held in multivariate analyses while statistically controlling for positive depression screening status, generalized anxiety symptom severity, and medical morbidity. Although the effect size surrounding the differential relations was small in magnitude, the present results further support the notion that metacognitive beliefs about uncontrollability relate less strongly to anxiety among U.S.-based ethnoracial minorities compared to White individuals. Potential reasons for the differential relations are discussed, along with additional areas for future research.

Dimensionality and Measurement Invariance of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and Validity Comparison With Measures of Negative Emotionality

This study explored the factor structure of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and measurement invariance between genders. We also measured concurrent and divergent validity of the STICSA as compared to the State-Trait Anxiety Inventory (STAI). A sample of 1064 (N Females = 855) participants completed questionnaires, including measures of anxiety, depression, stress, positive and negative affect. Confirmatory factor analyses supported the original factor structure of the STICSA, which was invariant between genders. Overall, the STICSA had superior concurrent and divergent validity as compared to the STAI. The somatic subscales were also significantly less correlated with depression, and positive and negative affect. Further, the somatic, as compared to cognitive anxiety STICSA subscales were less correlated with depression. This suggests that the STICSA, especially the somatic anxiety subscales, might hold the key to distinguishing between different types of anxiety, as well as between anxiety and depression.

Dimensionality of the State-Trait Inventory of Cognitive and Somatic Anxiety

The State-Trait Inventory of Cognitive and Somatic Anxiety (STICSA) is a commonly administered self-report instrument of state-trait cognitive and somatic anxiety. Extant research has consistently supported the intended oblique two-factor scoring structure for the STICSA. However, this model assumes that population-level data have (or approximate) a simple structure and that item-level variance is unidimensional. These assumptions may not be tenable and have unintended consequences for STICSA subscore interpretation. Consequently, we tested these assumptions by fitting confirmatory and exploratory structural equation models to STICSA scores for a diverse sample of college students enrolled at a large Southwestern university in the United States (n = 635). Results indicated that cognitive and somatic factors are not equally robust and that STICSA items appear to measure a nonnegligible mixture of both latent cognitive and somatic anxiety. It is recommended that future research use exploratory structural equation model in tandem with CFA to directly model data complexity.

Life stress and background anxiety are not associated with resting metabolic rate in healthy adults

This study examined associations between anxiety, stress, and resting metabolic rate (RMR). Thirty women and 23 men had RMR measured at two visits. Participants also had body composition assessed and completed several questionnaires: State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), Anxiety Sensitivity Index (ASI)-3, and Perceived Stress Scale (PSS)-14. The state version of the STICSA was completed at both visits, while the other questionnaires were completed at visit one. RMR was expressed in kilocalories per day and relative to lean mass (RMR_relative). Participants were divided into low-, medium-, and high-anxiety groups based on STICSA trait scores, and RMR was compared among groups using one-way ANOVA. Changes between visits were evaluated using paired t tests and Wilcoxon signed-rank tests. RMR did not change from visit one to visit two (1589 to 1586 kcal/day, p = 0.86) even though STICSA state scores slightly declined (Z-statistic = -2.39, p = 0.017). RMR_relative values were 30.3 ± 3.7, 29.0 ± 1.9, and 29.9 ± 3.6 kcal/kg of lean mass among low, medium, and high trait anxiety groups, respectively (F = 0.70, p = 0.50). No RMR variable significantly correlated with PSS-14, ASI-3, or STICSA scores. This study provides evidence that trait anxiety and life stress do not impact RMR. Whether an association between these factors exists in anxiety disorders remains to be evaluated. Novelty Contrary to previous research, this study found no associations between anxiety and RMR. It is doubtful whether practitioners need to account for healthy subjects' trait anxiety and stress when analyzing RMR data.

Dimensions of Anxiety, Age, and Gender: Assessing Dimensionality and Measurement Invariance of the State-Trait for Cognitive and Somatic Anxiety (STICSA) in an Italian Sample

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) is a widely used measure of state and trait anxiety that permits a specific assessment of cognitive and somatic anxiety. Previous research provided inconsistent findings about its factor structure in non-clinical samples (e.g., hierarchical or bi-factor structure). To date, no psychometric validation of the Italian version of the STICSA has been conducted. Our study aimed to determine the psychometric functioning of the Italian version of the STICSA, including its dimensionality, gender and age measurement equivalence, and convergent/divergent validity in a large sample of community-dwelling participants (N = 2,938; 55.9% female). Through confirmatory factor analysis, the multidimensional structure of both State and Trait STICSA scales, with each including Cognitive and Somatic dimensions, was supported. Factor structure invariance was tested and established at configural, metric, and scalar levels for males and females. Additionally, full factorial measurement invariance was supported for the State scale across young, middle age, and old adult groups whereas the Trait scale was partially invariant across age groups. The STICSA also showed good convergent validity with concurrent anxiety measures (State-Trait Anxiety Inventory and Beck Anxiety Inventory), and satisfactory internal discriminant validity with two depression measures (Teate Depression Inventory and Beck Depression Inventory-II). Results provided support for the multidimensionality of the STICSA, as well as the generalizability of the State and Trait scales as independent measures of Cognitive and Somatic symptomatology across gender in the general population. Implications for research and personality and clinical assessment are discussed.

Hardiness, Perseverative Cognition, Anxiety, and Health-Related Outcomes: A Case for and Against Psychological Hardiness

The present study investigates the utility of psychological hardiness as well as the differences between rumination and worry. Undergraduate students completed questionnaires assessing hardiness, worry, rumination, mindfulness, neuroticism, anxiety, somatization, coping, and health. Correlations and partial correlations controlling for neuroticism were examined. Hardiness was negatively correlated with neuroticism, rumination, worry, and anxiety and positively correlated with mindfulness, coping, and health. When neuroticism was statistically controlled, the relationships between hardiness and rumination, health, and coping became nonsignificant, and the relationships between hardiness and worry, mindfulness, and anxiety, although attenuated, remained significant. Rumination and worry were positively correlated, but when neuroticism was statistically controlled, this relationship became nonsignificant. The results suggest that hardiness is better conceptualized as a personality style that contributes to psychological well-being. Furthermore, our findings suggest that rumination and worry are distinct cognitive processes.